Metabolic approaches to treatment of melanoma

Purpose: Lactate dehydrogenase (LDH) levels in blood of patients with melanoma have proven to be an accurate predictor of prognosis and response to some treatments. Exclusion of patients with high LDH levels from many trials of new treatments has created a need for treatments aimed at patients with high LDH levels. This article reviews the metabolic basis for the association of LDH with prognosis and the treatment initiatives that may be successful in this patient group. Experimental Design: Review of current literature on the topic. Results: A number of new treatment initiatives based on manipulation of metabolic pathways in melanoma cells are now available and await evaluation in well-designed clinical trials. Conclusions: Different cancers may require different metabolic approaches for effective treatment. In view of the high rate of glycolysis in most melanoma cells, approaches based on inhibition of acid excretion from the cells seem particularly attractive.