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The treatment of metastatic malignant melanoma, a type of skin cancer that has spread to other parts of the body, often requires surgery, followed by additional therapy to help prevent or delay the cancer from returning. Now, researchers report that a biologic therapy, granulocyte-macrophage colony-stimulating factor (GM-CSF), may offer anti-melanoma activity, without the serious side effects of chemotherapy.

Malignant melanoma is a serious form of cancer that originates in the skin. Treatment options for melanoma depend on the

stage of disease (extent of cancer at diagnosis), and may include surgery, chemotherapy, radiation therapy, and/or biologic therapy.

Advanced or

metastatic melanoma (stage III and IV) is cancer that began in the skin and has spread to the nearby lymph nodes or to other parts of the body. Persons with this type of disease often undergo surgery to remove the cancer and surrounding tissue. However, even when all visible cancer is removed, there may still be some undetected cancer cells present. Therefore, persons who have stage III and IV melanoma often receive therapy after surgery, called

adjuvant therapy, with chemotherapy, radiation therapy, and/or biologic therapy to help kill more cancer cells and prevent or delay a

recurrence (return) of cancer. Researchers continue to develop and study more effective therapies to help control the symptoms of disease, enhance quality of life, and prolong survival time for persons with stage III and IV melanoma.

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One type of biologic therapy that has produced favorable preliminary results is

granulocyte macrophage colony-stimulating factor (GM-CSF), a type of cytokine (a substance in the body that helps to enhance the immune system). GM-CSF is a promising option for cancer therapy because of its potential to be effective against disease without the serious side effects of many chemotherapy drugs. Cytokines, such as GM-CSF, are most effective when there is only a minimal amount of cancer remaining after surgery.

Researchers from several medical centers treated 48 persons with stage III and IV melanoma. The patients underwent surgery, which resulted in the removal of all visible cancer. The patients then received GM-CSF every 28 days for 1 year. The outcomes of these patients were compared with those of past patients who had received surgery alone as treatment. The findings showed that the number of cancer recurrences were fewer in those who received GM-CSF after surgery. Moreover, the average survival time for persons having surgery alone was 12 months, compared with almost 38 months in those receiving GM-CSF. No significant side effects were associated with the GM-CSF therapy.

The researchers concluded that GM-CSF appears to have anti-cancer activity against malignant melanoma; however, they noted that these preliminary findings need to be studied further in large trials that compare this regimen directly with other adjuvant therapies. Persons who have stage III or IV melanoma may wish to talk with their doctor about the risks and benefits of receiving GM-CSF after surgery or of participating in a clinical trial in which other promising new treatments are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute

( and the Clinical Trials section and service offered by Cancer

( (

Journal of Clinical Oncology, Vol 18, No 8, pp 1614-1621, 2000)

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