Abstract
The purpose of this study was to compare the response rate, overall and 1-year survival in patients with advanced melanoma treated with a standard therapy, dacarbazine and interferon-alpha (DTIC/IFN), or combination chemotherapy, consisting of dacarbazine, BCNU, cisplatin and tamoxifen (DBCT). Treatment toxicity and time spent in hospital were secondary end points. One hundred and five patients (of whom 100 were eligible) were randomized to receive either DTIC/IFN or DBCT. The trial was designed to detect a 25% absolute difference in response rate or in 1-year survival with 80% power. There was no significant difference in response rate: this was 17.3% with DTIC/IFN and 26.4% with DBCT. Median overall survival was similar at 199 and 202 days respectively. One-year survival rate favoured standard treatment (30.6 vs 22.6%), but did not differ significantly between arms. DBCT was associated with significantly greater haematological toxicity, and a greater need for time spent in hospital (5.75 days/treatment cycle vs 2.29 with dacarbazine and interferon). DBCT combination therapy cannot be recommended as standard treatment for advanced melanoma. Dacarbazine remains the standard chemotherapy for this condition. © 2000 Cancer Research Campaign
Keywords: melanoma, chemotherapy
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- Atkins M. B. The treatment of metastatic melanoma with chemotherapy and biologics. Curr Opin Oncol. 1997 Mar;9(2):205–213. doi: 10.1097/00001622-199703000-00016. [DOI] [PubMed] [Google Scholar]
- Bajetta E., Di Leo A., Zampino M. G., Sertoli M. R., Comella G., Barduagni M., Giannotti B., Queirolo P., Tribbia G., Bernengo M. G. Multicenter randomized trial of dacarbazine alone or in combination with two different doses and schedules of interferon alfa-2a in the treatment of advanced melanoma. J Clin Oncol. 1994 Apr;12(4):806–811. doi: 10.1200/JCO.1994.12.4.806. [DOI] [PubMed] [Google Scholar]
- Chapman P. B., Einhorn L. H., Meyers M. L., Saxman S., Destro A. N., Panageas K. S., Begg C. B., Agarwala S. S., Schuchter L. M., Ernstoff M. S. Phase III multicenter randomized trial of the Dartmouth regimen versus dacarbazine in patients with metastatic melanoma. J Clin Oncol. 1999 Sep;17(9):2745–2751. doi: 10.1200/JCO.1999.17.9.2745. [DOI] [PubMed] [Google Scholar]
- Del Prete S. A., Maurer L. H., O'Donnell J., Forcier R. J., LeMarbre P. Combination chemotherapy with cisplatin, carmustine, dacarbazine, and tamoxifen in metastatic melanoma. Cancer Treat Rep. 1984 Nov;68(11):1403–1405. [PubMed] [Google Scholar]
- Falkson C. I., Falkson G., Falkson H. C. Improved results with the addition of interferon alfa-2b to dacarbazine in the treatment of patients with metastatic malignant melanoma. J Clin Oncol. 1991 Aug;9(8):1403–1408. doi: 10.1200/JCO.1991.9.8.1403. [DOI] [PubMed] [Google Scholar]
- Falkson C. I., Ibrahim J., Kirkwood J. M., Coates A. S., Atkins M. B., Blum R. H. Phase III trial of dacarbazine versus dacarbazine with interferon alpha-2b versus dacarbazine with tamoxifen versus dacarbazine with interferon alpha-2b and tamoxifen in patients with metastatic malignant melanoma: an Eastern Cooperative Oncology Group study. J Clin Oncol. 1998 May;16(5):1743–1751. doi: 10.1200/JCO.1998.16.5.1743. [DOI] [PubMed] [Google Scholar]
- Johnston S. R., Constenla D. O., Moore J., Atkinson H., A'Hern R. P., Dadian G., Riches P. G., Gore M. E. Randomized phase II trial of BCDT [carmustine (BCNU), cisplatin, dacarbazine (DTIC) and tamoxifen] with or without interferon alpha (IFN-alpha) and interleukin (IL-2) in patients with metastatic melanoma. Br J Cancer. 1998 Apr;77(8):1280–1286. doi: 10.1038/bjc.1998.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Keilholz U., Conradt C., Legha S. S., Khayat D., Scheibenbogen C., Thatcher N., Goey S. H., Gore M., Dorval T., Hancock B. Results of interleukin-2-based treatment in advanced melanoma: a case record-based analysis of 631 patients. J Clin Oncol. 1998 Sep;16(9):2921–2929. doi: 10.1200/JCO.1998.16.9.2921. [DOI] [PubMed] [Google Scholar]
- Lakhani S., Selby P., Bliss J. M., Perren T. J., Gore M. E., McElwain T. J. Chemotherapy for malignant melanoma: combinations and high doses produce more responses without survival benefit. Br J Cancer. 1990 Feb;61(2):330–334. doi: 10.1038/bjc.1990.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lee S. M., Betticher D. C., Thatcher N. Melanoma: chemotherapy. Br Med Bull. 1995 Jul;51(3):609–630. doi: 10.1093/oxfordjournals.bmb.a072982. [DOI] [PubMed] [Google Scholar]
- Legha S. S., Ring S., Bedikian A., Plager C., Eton O., Buzaid A. C., Papadopoulos N. Treatment of metastatic melanoma with combined chemotherapy containing cisplatin, vinblastine and dacarbazine (CVD) and biotherapy using interleukin-2 and interferon-alpha. Ann Oncol. 1996 Oct;7(8):827–835. doi: 10.1093/oxfordjournals.annonc.a010762. [DOI] [PubMed] [Google Scholar]
- Luikart S. D., Kennealey G. T., Kirkwood J. M. Randomized phase III trial of vinblastine, bleomycin, and cis-dichlorodiammine-platinum versus dacarbazine in malignant melanoma. J Clin Oncol. 1984 Mar;2(3):164–168. doi: 10.1200/JCO.1984.2.3.164. [DOI] [PubMed] [Google Scholar]
- Margolin K. A., Liu P. Y., Flaherty L. E., Sosman J. A., Walker M. J., Smith J. W., 3rd, Fletcher W. S., Weiss G. R., Unger J. M., Sondak V. K. Phase II study of carmustine, dacarbazine, cisplatin, and tamoxifen in advanced melanoma: a Southwest Oncology Group study. J Clin Oncol. 1998 Feb;16(2):664–669. doi: 10.1200/JCO.1998.16.2.664. [DOI] [PubMed] [Google Scholar]
- McClay E. F., Mastrangelo M. J., Berd D., Bellet R. E. Effective combination chemo/hormonal therapy for malignant melanoma: experience with three consecutive trials. Int J Cancer. 1992 Feb 20;50(4):553–556. doi: 10.1002/ijc.2910500410. [DOI] [PubMed] [Google Scholar]
- Mulder N. H., van der Graaf W. T., Willemse P. H., Koops H. S., de Vries E. G., Sleijfer D. T. Dacarbazine (DTIC)-based chemotherapy or chemoimmunotherapy of patients with disseminated malignant melanoma. Br J Cancer. 1994 Oct;70(4):681–683. doi: 10.1038/bjc.1994.372. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nathanson L., Kaufman S. D., Carey R. W. Vinblastine, infusion, bleomycin, and cis-dichlorodiammine-platinum chemotherapy in metastatic melanoma. Cancer. 1981 Sep 15;48(6):1290–1294. doi: 10.1002/1097-0142(19810915)48:6<1290::aid-cncr2820480605>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
- Richards J. M., Mehta N., Ramming K., Skosey P. Sequential chemoimmunotherapy in the treatment of metastatic melanoma. J Clin Oncol. 1992 Aug;10(8):1338–1343. doi: 10.1200/JCO.1992.10.8.1338. [DOI] [PubMed] [Google Scholar]
- Rosenberg S. A., Yang J. C., Schwartzentruber D. J., Hwu P., Marincola F. M., Topalian S. L., Seipp C. A., Einhorn J. H., White D. E., Steinberg S. M. Prospective randomized trial of the treatment of patients with metastatic melanoma using chemotherapy with cisplatin, dacarbazine, and tamoxifen alone or in combination with interleukin-2 and interferon alfa-2b. J Clin Oncol. 1999 Mar;17(3):968–975. doi: 10.1200/JCO.1999.17.3.968. [DOI] [PubMed] [Google Scholar]
- Rusthoven J. J., Quirt I. C., Iscoe N. A., McCulloch P. B., James K. W., Lohmann R. C., Jensen J., Burdette-Radoux S., Bodurtha A. J., Silver H. K. Randomized, double-blind, placebo-controlled trial comparing the response rates of carmustine, dacarbazine, and cisplatin with and without tamoxifen in patients with metastatic melanoma. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 1996 Jul;14(7):2083–2090. doi: 10.1200/JCO.1996.14.7.2083. [DOI] [PubMed] [Google Scholar]
- Schultz M. Z., Buzaid A. C., Poo W. J. A phase II study of interferon-alpha 2b with dacarbazine, carmustine, cisplatin and tamoxifen in metastatic melanoma. Melanoma Res. 1997 Apr;7(2):147–151. doi: 10.1097/00008390-199704000-00009. [DOI] [PubMed] [Google Scholar]
- Thompson J. A., Gold P. J., Fefer A. Outpatient chemoimmunotherapy for the treatment of metastatic melanoma. Semin Oncol. 1997 Feb;24(1 Suppl 4):S44–S48. [PubMed] [Google Scholar]