Short CommunicationTreatment of metastatic malignant melanoma with dacarbazine plus fotemustine
Introduction
The prognosis of metastatic malignant melanoma is poor and treatment with chemotherapy is highly unsatisfactory. Dacarbazine (DTIC) is the most effective single agent with a response rate of up to 20%. Hence, various combination chemotherapy regimens have been tested in an attempt to improve the response rate[1]. Of these the polychemotherapy with DTIC and fotemustine has shown promising results, but the sequential scheduling of these drugs has been complicated by lung toxicity2, 3, 4. We report the clinical response of an adjusted sequential combination treatment with DTIC at a dose of 200 mg/m2 followed 24 h later by fotemustine 100 mg/m2 every 4 weeks in 63 unselected patients with metastatic melanoma.
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Patients and methods
74 patients with progressive, metastatic malignant melanoma were treated with DTIC at a dose of 200 mg/m2 followed 24 h later by fotemustine 100 mg/m2 intravenously. Therapy was repeated every 4 weeks for up to 10 courses or until progression. Response was assessed monthly by clinical examination, complete blood cell count, renal and liver blood chemistry. Chest X-ray, computed tomography scan, bone scan, abdomen ultrasound and sonography of the axillary and inguinal lymph nodes were performed
Results
Out of 74 patients treated, 63 were evaluable for response. 43 were men and 20 women aged from 27 to 82 years (median age 57 years). 29 of the 63 patients were pretreated. 15 patients had received immunotherapy with interferon alpha and 14 patients had prior chemotherapy (4 patients with carmustine, 5 patients with DTIC, 3 patients with cisplatin/carboplatin and 2 patients with cisplatin/tamoxifen). Of these patients, 7 patients had more than one prior therapies, including two patients who had
Discussion
Following the introduction of fotemustine, a new nitrosurea with special activity on brain metastases, for the treatment of disseminated malignant melanoma[6], the combination of fotemustine with the most effective single agent DTIC has been tested in several studies using two main schedules2, 3, 4, 6. The alternating combination of fotemustine and DTIC with fotemustine given on days 1 and 8 and DTIC given on days 15–18 or 2–5 yielded objective response rates of 27.2%, 11.7% and 30.8%,
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