Implications for clinical practice

Treatment for malignant MM remains unsatisfactory. Response rates often appear encouraging in single-centre single-arm studies but when the treatments have been tested in larger, multicentre randomised trials, results have to date been very disappointing. Responses are usually partial (10-25% of patients), rarely complete (less than 10%) and are of short duration (median overall survival approximately 6 months).

Outside of clinical trials, standard therapy should remain as single-agent dacarbazine, with temozolamide for selected patients such as those in whom intravenous therapy may particularly interfere with quality of life and possibly those with predominantly cranial metastases.

Does immunotherapy help, used either alone or with cytotoxic therapy?

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