RT Book, Section A1 Sandhu, Shahneen A1 Smalley, Keiran A1 McArthur, Grant A2 Morita, Shane Y. A2 Balch, Charles M. A2 Klimberg, V. Suzanne A2 Pawlik, Timothy M. A2 Posner, Mitchell C. A2 Tanabe, Kenneth K. SR Print(0) ID 1145756161 T1 Systemic Treatment for Stage IV Melanoma T2 Textbook of Complex General Surgical Oncology YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9780071793315 LK hemonc.mhmedical.com/content.aspx?aid=1145756161 RD 2024/10/07 AB Metastatic melanoma continues to place a substantial economic burden on western caucasian populations because of the disproportionately high incidence in young patients.1 Historically, the prognosis for patients with metastatic disease has been dismal with a median overall survival (OS) of 6 to 9 months and a 5-year survival rate of less than 10%.2 Until 2011, only dacarbazine and high-dose interleukin 2 (IL-2) were approved for the treatment of metastatic disease. Dacarbazine gained approval in 1975 for its modest response rate of 10% and median OS of 5.6 to 9.7 months.2,3 Attempts to improve on this with other cytotoxics (temozolomide or fotemustine), cisplatin-based combination chemotherapy, biochemotherapy, and concurrent use of targeted agents with dacarbazine resulted in marginally higher response rates, additional toxicity but no added survival advantage over single agent dacarbazine.3-6 High-dose IL-2 has consistently demonstrated an objective response rate (ORR) of 16% to 23% with durable complete responses seen in approximately 5% to 10% of patients.7 High-dose IL-2, however, requires skilled inpatient management, which has largely restricted clinical application to a small number of highly specialized centers.