The use of interferon alfa as adjuvant therapy for advanced cutaneous melanoma: the need for more evidence.

Interferon alfa is rapidly gaining acceptance as the standard of care for patients with advanced but nonmetastatic cutaneous malignant melanoma. The randomized trials of interferons for melanoma are reviewed with attention to any survival benefits demonstrated by these studies. Because none of these studies are placebo controlled, questions regarding the placebo effects interferons may possess are addressed, as is an analogous clinical scenario in which interferons appeared to be beneficial in nonplacebo controlled trials but were shown to be ineffective in placebo-controlled trials. Moreover, given the significant toxicities and financial costs of interferons, the argument is advanced that interferon alfa should not become the standard of care for melanomas until the results of randomized, placebo-controlled trials evaluating the survival advantages of interferon alfa for melanoma become available.