Stage IV melanoma is diagnosed when the melanoma has spread from the original site to distant parts of the body; stage IV is classified as having a tumor with lymph node involvement and a metastasis. After evaluating the metastases with CT, MRI and PET scans, the medical team can determine the best plan of therapy. This stage of the disease is very difficult to treat and may require a combination of several treatments to achieve improvement, if possible.
Palliative Surgery
Since the disease has spread to other areas of the body in stage IV melanoma, surgery is not able to facilitate a cure. Some surgeons may try to remove metastases if they can be reached surgically and are causing symptoms. According to the MD Anderson website, many surgeons do not usually operate on these metastases and try to improve life span and quality of life with systemic therapies.
Chemotherapy
Although chemotherapy regimens have limited effectiveness in metastatic melanoma, there are some agents that offer some success. Dacarbazine and temozolomide--used by themselves or in combination with other agents--are the most commonly used chemotherapy drugs, according to the American Cancer Society, but the effectiveness of these medications is limited--lasting only about three to six months. Occasionally, the improvement lasts for longer periods of time.
Biologic Therapy
Biology therapy works by using the immune system of the body to fight the cancer cells. Two biologic agents that are used to treat stage IV melanoma are interferon-alpha or interleukin-2; however, as noted on the National Cancer Institute website, the response rates for interferon-alpha is around eight to 22 percent, while the response rates for interleukin-2 are similar. Higher doses of these medications may have higher efficacy rates, but also cause greater numbers of side effects.
Radiation Therapy
High-energy X-rays are used to destroy tumor cells during radiation therapy. This therapy can provide relief from symptoms in the brain, bones or other parts of the body by applying radiation to the area and shrinking the metastases. As mentioned on the MD Anderson website, radiation therapy can also be combined with chemotherapy drugs, which is called chemoradiation to treat metastatic melanoma.
Combination Therapy
Combinations of chemotherapy drugs and biologic agents have been evaluated in the treatment of stage IV melanoma. According to the American Cancer Society, physicians have combined interferon with temozolomide, and interferon, interleukin and temozolomide with some benefit, but no lasting cures. As noted on the National Cancer Institute website, M. Huncharek and colleagues found in a 2001 study in the "Journal Melanoma Research that" the combination of dacarbazine with interferon-alpha had a response rate of over 50 percent; however, this did not translate to longer survival rates.
Clinical Trials
Since stage IV melanoma is so difficult to treat, many patients find themselves participating in clinical trials to find a therapy for the disease. There are clinical trials that are evaluating the effectiveness of monoclonal antibodies, which can stimulate the body's immune system to attack cancer cells, as well as other trials that are evaluating other combinations of dacarbazine or temozolomide with other experimental agents. Targeted therapies, which are drugs that interfere with cancer cell growth by disrupting a specific target on the cancer cells are also being evaluated for metastatic melanoma. According to an article written by Ravi K. Amaravadi and Keith T. Flaherty in a 2007 issue of "Clinical Advances in Hematology & Oncology," targeted agents such as sorafenib, bevacizumab and imatinib are being studied for their efficacy.
