Chemotherapy in metastatic melanoma - still useful or out of date?

to chemotherapy rather than to tamoxifen, because the latter has already been demonstrated to show no benefit when applied in addition to chemotherapy compared to chemotherapy alone [5]. However, a positive effect of tamoxifen on the maintenance of a chemotherapy response cannot be excluded and has never been tested in a prospectively randomized study. The observations of Metzner et al. [4] indicate that chemotherapy is still a promising treatment option in metastatic melanoma, and should be considered all lines of therapy after testing for gene mutations selective for currently available kinase inhibitors. In patients whose tumors harbor no specific gene mutations, chemotherapy could serve as first-line therapy. In patients tested positive for a genetic aberration allowing treatment with targeted agents, chemotherapy could be used as secondor third-line therapy following resistance against the kinase inhibitors used in first line. The major obstacle for chemoand immunotherapy of metastatic melanoma that has to be overcome is the current lack of reliable biomarkers helping to identify patients who are likely to benefit from either therapy. In this regard, the ongoing phase III trial ChemoSensMM of the Dermatologic Cooperative Group (DeCOG, ADO) in Germany and Austria investigates a methodo logy of ex-vivo sensitivity profiling [6] to allow an individualized, sensitivity-driven polychemotherapy versus DTIC in metastatic melanoma. It should be further noticed, that this methodology can also be used to test targeted therapeutics. If this trial achieves a positive result, chemotherapy will persist as one of the major mainstays in the treatment of metastatic melanoma.