Chemotherapy uses drugs that kill cancer cells. Systemic chemotherapy uses anti-cancer drugs that are usually injected into a vein or given by mouth. These medicines travel through the bloodstream to all parts of the body (the reason it is called systemic) and attack cancer cells that have already spread beyond the skin to involve lymph nodes and other organs.

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects may include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• lowered resistance to infection (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelets)
• fatigue (due to low red blood cells)

These side effects are usually short-term and go away once treatment is finished.

Be sure to talk with your cancer care team about any side effects you have because there are often ways to lessen them. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Several types of systemic chemotherapy can be used to treat advanced melanoma. Although chemotherapy is usually not as effective in melanoma as in some other types of cancer, it may relieve symptoms or extend survival for some patients.

Several chemotherapy drugs may be used to treat melanoma:

• Dacarbazine (also called DTIC), may be used either alone or in combination with other chemotherapy drugs such as carmustine (also known as BCNU) and cisplatin. The combination of these 3 drugs, together with tamoxifen (a hormonal therapy drug) is called the "Dartmouth regimen."

• Cisplatin, vinblastine, and DTIC is another chemotherapy combination for treating melanoma. This is known as the "CVD regimen."

• Temozolomide (Temodar) is a drug that works similar to DTIC, but it can be given in the form of a pill. It may be given by itself, although some studies have shown the drug to be more effective when combined with interferon.

• Paclitaxel is a drug sometimes used to treat melanoma, either alone or combined with drugs such as cisplatin or carboplatin.

It is not clear if using combinations of chemotherapy drugs is much better than using a single drug. Some studies have found that combining chemotherapy drugs with 1 or more immunotherapy drugs (interferon-alpha and/or interleukin-2) may be more effective than a single chemotherapy drug alone, although it's not clear if this helps people live longer. This type of treatment is also called biochemotherapy or chemoimmunotherapy.

Isolated limb perfusion is a type of chemotherapy sometimes used to treat advanced melanomas confined to an arm or leg. It is done during a surgical procedure. Instead of giving chemotherapy into a vein and letting it go throughout the body, this method temporarily separates the blood flow of the involved limb from the rest of the body and injects high doses of chemotherapy into the artery feeding the limb. This allows high doses to be given to the area of the tumor without exposing internal organs to these doses, which would otherwise cause severe side effects. Usually the chemotherapy fluid is warmed before being given, which may help make it work better. Melphalan is the chemotherapy drug most often used in this procedure.

Last Medical Review: 06/05/2008
Last Revised: 05/14/2009