Tamoxifen vs. non‐tamoxifen treatment for advanced melanoma: a meta‐analysis

Abstract

Although tamoxifen (TAM) is routinely used in advanced melanoma, it is still uncertain whether evidence exists to support this practice. This review assesses the benefits and harms of systemic therapy with TAM vs. without TAM on response and mortality in patients with advanced melanoma. MEDLINE, The Cochrane Database of Systemic Reviews, The Cochrane Central Register of Controlled Trials, EMBASE and LILACS were searched for randomized controlled trials comparing chemotherapy using and not using TAM in any dose, in patients of any age with advanced melanoma. References lists, databases of ongoing trials and conference proceedings were hand-searched. All included trials were evaluated for quality assessment. Primary outcomes were response and mortality. Secondary outcomes were hematologic and non hematologic toxicity, treatment-related mortality and quality of life. A meta-analysis was performed and results were presented as relative risk with 95% confidence interval. Nine randomized controlled trials met the inclusion criteria. Patients treated with TAM were more likely to respond, with a relative risk 1.36 (95% CI: 1.04-1.77, P = 0.02). However, there was no improvement in 1-year mortality. The incidence of hematologic toxicity was higher in the TAM group. Subgroup analyses showed that female patients were more likely to respond. Chemotherapies with TAM improve overall and partial response, but do not improve mortality in 1 year in advanced melanoma. Further use of TAM in melanoma should be done only in the context of clinical trials.

Rethinking tamoxifen in the management of melanoma: New answers for an old question

“…More recently, in a meta-analysis including nine randomized controlled trials, the inclusion of tamoxifen in systemic chemotherapy improved the overall and the partial response of patients with advanced melanoma, with female patients being more likely to respond (Beguerie et al, 2010). However, the incidence of hematologic toxicity was higher in the tamoxifen group, and there was no improvement in 1-year mortality (Beguerie et al, 2010).…”

Estrogen Receptor β in Melanoma: From Molecular Insights to Potential Clinical Utility

“…The effects of chemotherapy with and without tamoxifen for the treatment of aggressive melanoma were compared in different clinical trials. These studies reported that co-treatment with tamoxifen may provide improvements in response rates, although it is often accompanied by increased toxicity and no survival benefit (60, 127–131). It has been proposed that this is due to the fact that tamoxifen may decrease cell proliferation when it binds to ERα while it may increase cell proliferation when it binds to ERβ (60).…”

Long-Term Remissions in Metastatic Malignant Melanoma Following Chemotherapy and Tamoxifen Maintenance

“…Tamoxifen monotherapyinmetastaticmelanomahasbeenreportedtoinduce remissions in about 5% of the patients, in some cases after progressionofthediseaseinthefirstmonthsoftherapy [5]. Incombinationwithchemotherapy,tamoxifenfailedtoexert an additional therapeutic effect in most studies [6]. But, to our knowledge, no results are published about tamoxifen maintenancefollowingchemotherapy.…”