In the year 2015, it is estimated that the number of new cases of invasive melanoma will be 42,670 in males and 31,200 in females.1 Melanoma is treatable with early diagnosis; however, more advanced disease has devastating outcomes. For the past decade, two chemotherapy agents, dacarbazine and temozolomide, have been the treatment of choice for advanced stage III or IV melanoma requiring systemic treatment. Interleukin-2 (IL-2) therapy has been used but with serious side effects. More recently, the focus has shifted to monoclonal antibodies and enzyme inhibitors as the main systemic treatment for advanced cutaneous melanoma. This literature review gathered several studies which looked at the use of monoclonal antibodies, and compared monoclonal antibodies to conventional chemotherapy to assess whether there is a significant difference in tumor response, sustained remissions and side effect profile. An extensive medical literature review was conducted with PubMed and Cochrane databases using the keywords: “monoclonal antibody,” “melanoma,” and “treatment.” This list of articles was further narrowed by specific inclusion and exclusion criteria as well as reviewed for validity and quality using the GRADE system. Seven clinical trials were included in this literature review. One observational study evaluated the overall safety and efficacy of monoclonal antibodies, while another compared monoclonal antibodies versus placebo under the same variables. Three of the research studies were randomized clinical trials evaluating the safety and efficacy of monoclonal antibodies in comparison to chemotherapy. Two retrospective studies assessed patients from expanded access programs who did not meet criteria to participate in a clinical trial. All seven studies had similar inclusion and exclusion criteria and the patients were prognostically similar before starting treatment. Six out of the seven studies demonstrated superiority of monoclonal antibodies advanced-stage melanoma treatment. One study failed to demonstrate a statistically significant survival advantage over traditional chemotherapy. The use of monoclonal antibodies has been demonstrated to be a more specific and effective treatment approach than other therapies tried in the past. While monoclonal antibodies have demonstrated efficacy in first line treatment for advanced stage melanoma, further research is necessary to determine which combination of medications is most beneficial for these patients.
Critical Appraisal on the Selection Criteria for Evidence-based Healthcare
