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Melanoma of the skin
Locoregional metastases (stage III) are considered a crucial stage in treatment of the disease, and this provided the subject of a clinical study conducted with Avemar. A complete resection of positive lymph nodes should be performed, though the isolated perfusion of in-transit metastases and/or inoperable primary tumours of the extremities through the use of melphalan or tumour necrosis factor (TNF?) represents another therapeutic approach. However, as the facilities needed for such treatment are available in very few centres, most patients choose radiotherapy treatment. Systemic adjuvant chemotherapy is recommended after a complete resection, but there is as yet no standard accepted form of such therapy. Nevertheless, the basic component of all chemotherapy is Dacarbazine, and no combination of cytostatic drugs has proven more effective than Dacarbazin monotherapy.
Considering the poor efficacy of standard therapy, it is particularly noteworthy that the application of Avemar as a supportive therapy enhanced the effect of Dacarbazine therapy in stage III melanoblastoma. Demidov and his colleagues, after an average observation period of 12 months for a group of 46 stage III melanoma patients (24 standard, 22 standard + Avemar), reported a significant decrease in progression-related events (recurrence of the primary tumour, recurrence of lymph node metastases, new lymph node metastases, development of distant (visceral) metastases) in the Avemar group. The average progression-free interval was 306 days for the Avemar group versus 213 for the control group. The average length of time without distant metastases was 340 days for the Avemar group versus 255 for the control group. The number of progression-related events was 10 for the Avemar group versus 38 for the control group. No new distant metastases developed in the Avemar group, as compared with 5 in the control patients. There was one recurrent lymph node metastasis in the Avemar group compared with 9 in the control group.
Conclusions: the use of Avemar as a supportive therapy reduced the overall risk of progression-related events by 52.2%. As a result, the application of Avemar as a complementary treatment in stage III melanoma is strongly recommended.
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