Chemotherapy is a systemic treatment in which anticancer drugs are usually injected into a vein or given by mouth. These medications travel through the bloodstream and attack melanoma cells that have already spread beyond the skin to involve lymph nodes and other organs.

Chemotherapy is not as effective for melanoma as for some other types of cancer, but it may relieve symptoms of some patients with stage IV melanoma. It has also been investigated as an adjuvant therapy to kill any cancer cells that may remain after melanoma surgery. Clinical trials are being conducted to find more effective adjuvant chemotherapy medications.

Single-Agent Chemotherapy

The most commonly used single-agent chemotherapies are listed below.

• Dacarbazine (brand name DTIC) is the only chemotherapy treatment for melanoma approved by the Food and Drug Administration
(FDA), and the most commonly prescribed. It is typically administered intravenously. Studies have shown dacarbazine causes tumor shrinkage in 15 to 20% of patients for an average of six months before the tumors resume growth.¹ To date, dacarbazine has not been shown to significantly prolong overall survival.
• Temozolomide (brand name Temodar) is an oral drug for the treatment of advanced, metastatic melanoma. Clinical trials have shown
temozolomide is as effective as dacarbazine and easier to administer, with fewer side effects.²
• Cisplatin: one of a group of drugs known as alkylating agents
• Carmustine (also known as BCNU) and fotemustine: two drugs belonging to a group of drugs known as nitrosoureas
• Other chemotherapy agents include vindesine, vincristine, bleomycin, and paclitaxel

Combination Chemotherapy

Combination chemotherapy, the use of combinations of multiple chemotherapy drugs, has not been proven to be superior to single agents. Combination chemotherapies are listed below.

• Dartmouth regimen: a combination of dacarbazine, carmustine cisplatin, and tamoxifen (a hormonal therapy drug most often used to treat breast cancer). Clinical trials have not shown it to be significantly more effective than dacarbazine alone, although severe side effects were significantly more common in the Dartmouth regimen.³
• CVD: a combination of cisplatin, vinblastine, and dacarbazine. Studies have not shown CVD to be significantly more effective than dacarbazine alone.

See also Biochemotherapy.