Vinblastin-carboplatin for metastatic cutaneous melanoma as first-line chemotherapy and in dacarbazine failures
- 41 Downloads
First-line treatments of metastatic melanoma are usually decarbazine (DTIC) and/or α-interferon based, with response rates in the range of at most 20–30%. In this study, initiated, in fact, by a temporary DTIC shortage in the country, we have assessed the efficacy and toxicity of a vinblastine — carboplatin regimen for metastatic melanoma. The regimen was subsquently applied in two cohorts of patients: a chemotherapy-naive one and in DTIC failures (because the regimen was claimed non-cross-resistant). The regimen contained 6 mg/m2 vinblastine on d 1 and 450 mg/m2 carboplatin on d 1 for 3 wk. In the chemotherapy-naïve cohort, 50 patients were included, 29 males and 21 females, median age 54 yr (range: 33–68), performance status 0+1 for 26 patients and 2+3 for 24 patients. Forty-eight patients were evaluable for activity. The response was the following: complete response (CR), 1/48 (2%); partial response (PR), 13/48 (27%); stable disease (SD), 20/48 (42%); progressive disease (PD), 14/48 (29%). The overall response rate was 14/48 (29%). The median response duration was 7 mo (range: 3–14); the median time to progression was 4 mo (range: 2–14). Toxicity included granulocytopenia and thrombocytopenia grade IV in 3/50 patients and nausea grade II in 8/50 patients. In the DTIC-failures cohort, 58 patients were included, 38 males and 20 females, median age 51 yr (range: 20–65), performance status 0+1 for 25 patients and 2+3 for 33 patients. All 58 patients were evaluable for activity. The response was the following: CR 3/58 (5%), PR 4/58 (7%), SD 10/58 (17%), PD 41/58 (71%). The overall response rate was 7/58 (12%). The median response duration was 11 mo (range: 3–24); the median time to progression was 4 mo (range: 2–24). Toxicities included granulocytopenia grade IV in 4/58 patients and nausea grade II in 4/58 patients. Thus, despite the fact that the regimen achieved a response rate comparable to DTIC in a first-line setting, the lack of cross-resistance did not prevent it from being of limited activity in DTIC failures, although, even in this group, several long-lasting responses and stabilizations were noted.
Key wordsMelanoma metastatic primary chemotherapy salvage chemotherapy vinblastine carboplatin
Unable to display preview. Download preview PDF.
- 1.Balch, C.M., et al. (1997). Cutaneous melanoma, in Cancer: Principles and Practice of Oncology, 5th ed. (V.T. De Vita, et al. eds.), pp. 1947–1994, Lippincot-Raven, New York.Google Scholar
- 3.Mastrangelo, M.J., Bellet, R.F. and Berd, D. (1979). Immunology and immunotherapy of human cutaneous malignant melanoma, in Human Malignant Melanoma (W.H. Clarck, Jr., L.I. Goldman, and M.J. Mastrangelo, eds.), p. 355, Grune and Stratton, New York.Google Scholar
- 18.Kirchner, H.H., Atzpodien, J. and Poliwoda, H. (1996). Chemo-immunotherapy in advanced malignant melanoma: carboplatin and DTIC or cisplatin, DTIC, BCNU and tamoxifen followed by immunotherapy with interleukin 2 and interferon alpha-2a. Med. Klin. 91(Suppl. 1.3):44–49.Google Scholar
- 24.Swinnen, L.J., Ellis, N.K. and Erickson, L.C. (1991). Inhibition of cis-diammine-1, 1-cyclobutane dicarboxylatoplatinum (II)-induced DNA interstand cross-link removal and potentiation of cis-diammine-1, 1-cyclobutane dicarboxylatoplatinum (II) cytotoxicity by hydroxyurea and 1-beta-d-arabinofuranosylcytosine. Cancer Res. 51(8):1984–1989.PubMedGoogle Scholar