Adjuvant Therapy in Malignant Melanoma: A Trial of Immunotherapy, Chemotherapy, and Combined Treatment

  • S. D. Kaufman
  • A. B. Cosimi
  • W. C. Wood
  • R. W. Carey
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 68)


Two hundred thirteen patients with malignant melanoma who underwent resection with curative intent were studied retrospectively at the Massachusetts General Hospital, and a group at high risk of recurrence was identified. The patients were classified by pathologic criteria utilizing Clark’s levels. All of the patients in this group had lesions of levels III, IV, or V with vertical thickness exceeding 1.5 mm [2, 3] and/or metastases to regional lymph nodes. This corresponds to stage II of the 1977 American Joint Commission For Cancer Staging and End Results Reporting. The observed recurrence rate in this group of patients was 25% at 1 year and 50% at 5 years. Many of these patients had distant metastases without evidence of local failure. This finding strongly suggests, though it does not prove, the presence of subclinical metastatic disease at the time of initial surgical treatment. The concept of clinically undetectable micrometastases with an important role for adjuvant treatment with chemotherapy is exemplified in the treatment of other solid tumors, notably carcinoma of the breast.


Toxicity Hepatitis Acetone Depression Corticosteroid 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Beretta, G.: Controlled study for prolonged chemotherapy, immunotherapy, and chemotherapy plus immunotherapy as an adjuvant to surgery in Stage I–II malignant melanoma: Preliminary report. In: Immunotherapy of cancer. Present status of trials in man. Terry, W. D., Windhorst, D. (eds.). New York: Raven Press 1978.Google Scholar
  2. 2.
    Breslow, R.: Tumor thickness, level of invasion and node dissection in Stage I cutaneous melanoma. Ann. Surg. 182, 572 (1975).PubMedCrossRefGoogle Scholar
  3. 3.
    Clark, W. M. (Jr.), From, L., Bernadino, E. A., Mihm, M. C.: The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res. 29, 705 (1969).PubMedGoogle Scholar
  4. 4.
    Cox, D. R.: Regression models and life tables (with discussion). J. R. Statist. Soc. B 34, 187 (1972).Google Scholar
  5. 5.
    Cutler, S. F., Ederer, F.: Maximum utilization of the life table method in analyzing survival. J. Chronic. Dis. 8, 699 (1958).PubMedCrossRefGoogle Scholar
  6. 6.
    Eilber, F. R., Holmes, E. C., Morton, D. L.: Immunotherapy as an adjunct to surgery in the treatment of cancer. World J. Surg. 1, 547 (1977).PubMedCrossRefGoogle Scholar
  7. 7.
    Eilber, F. R., Holmes, E. C., Ramming, K. P., Sparks, F. C., Morton, D. L.: Adjuvant immunotherapy of Stage II malignant melanoma. N.E.J.M. 294, 237 (1976).CrossRefGoogle Scholar
  8. 8.
    Eilber, F. R., Morton, D. L., Holmes, E. C., Sparks, F. C. et al.: Adjuvant immunotherapy with BCG in treatment of regional-lymph-node metastases from malignant melanoma. N.E.J.M. 294, 237 (1976).CrossRefGoogle Scholar
  9. 9.
    Gutterman, J. U., Mavligit, G., Gotlieb, J. A., Burgess, M. A. et al.: Chemoimmunotherapy of disseminated malignant melanoma with dimethyl triazeno imidazole carboxamide and bacillus Calmette-Guerin. N.E.J.M. 291, 592 (1974).CrossRefGoogle Scholar
  10. 10.
    Gutterman, J. U., Mavligit, G. M., McBride, C., Frei, E. et al.: Active immunotherapy with BCG for recurrent malignant melanoma. Lancet 1973/I, 208.Google Scholar
  11. 11.
    Hill, G. J., Grage, J. B., Minton, J. P., Krementz, E. T. et al.: DTIC-melanoma randomized surgical adjuvant study. A.S.C.O. Abs. 1007 (1975).Google Scholar
  12. 12.
    Mantel, N.: Evaluation of survival data and two rank order statistics arising in its consideration. Cancer Chemother. Rep. 50, 163 (1966).PubMedGoogle Scholar
  13. 13.
    Mastrangelo, M. J., Bellet, R. E., Berkelhammer, J., Clark, W. H. (Jr.): Regression of pulmonary metastatic disease associated with intralesional BCG therapy of intracutaneous melanoma metastases. Cancer 36, 1305 (1975).PubMedCrossRefGoogle Scholar
  14. 14.
    McIllmurray, M. B., Embleton, M. J., Reeves, W. C., Langman, M. J. S. et al.: Controlled trial of active immunotherapy in management of Stage II-B malignant melanoma. Br. Med. J. 1977/I, 540.Google Scholar
  15. 15.
    McKelvey, E. M., Luce, J. K., Talley, R. W., Hersh, E. M. et al.: Combination chemotherapy with Bis chloroethyl nitrosurea (BCNU), vincristine and dimethyl triazeno imidazole carboxamide (DTIC) in disseminated malignant melanoma. Cancer 39, 1 (1977).PubMedCrossRefGoogle Scholar
  16. 16.
    McKelvey, E. M., Luce, J. K., Vaitkevicius, V. K., Talley, R. W. et al.: Bis chloroethyl nitrosurea, vincristine, dimethyl triazeno imidazole carboxamide and chlorpromazine combination chemotherapy in disseminated malignant melanoma. Cancer 39, 5 (1977).PubMedCrossRefGoogle Scholar
  17. 17.
    Morton, D. L., Eilber, F. R., Malmgren, R. A., and Wood, W. C.: Immunological factors which influence response to immunotherapy in malignant melanoma. Surgery 68, 158 (1970).PubMedGoogle Scholar
  18. 18.
    Nathanson, L.: Regression of intradermal malignant melanoma after intralesional injection of mycobacterium bollis strain BCG. Cancer Chemother. Rep. 56, 659 (1972).PubMedGoogle Scholar
  19. 19.
    Pinsky, C., Hirshaut, Y., Oestgen, H.: Treatment of malignant melanoma by intralesional injection of BCG. Proc. Am. Assoc. Cancer Res. 13, 21 (1972).Google Scholar
  20. 20.
    Pinsky, C. M., Hirshaut, Y., Wanebo, W. J., Fortner, J., et al.: Surgical adjuvant immunotherapy in patients with malignant melanoma: A prospective, randomized trial. In: Immunotherapy of cancer Present status of trials in man. Terry, W. D., Windhorst, D. (eds.). New York: Raven Press 1978.Google Scholar
  21. 21.
    Seigler, H. F., Shingleton, W. W., Metzgar, R. S., Buckley, C. E. et al.: Nonspecific and specific immunotherapy in patients with melanoma. Surgery 72, 162 (1972).PubMedGoogle Scholar
  22. 22.
    Sparks, F. C., Silverstein, M. J., Hunt, J. S., Morton, D. L.: Complications of BCG immunotherapy in patients with cancer. N.E.J.M. 289, 827 (1973).CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1979

Authors and Affiliations

  • S. D. Kaufman
  • A. B. Cosimi
  • W. C. Wood
  • R. W. Carey

There are no affiliations available

Personalised recommendations