Punt 2006.

Study characteristics
Methods	Phase II parallel‐group RCT. Open label study.
Participants	Untreated metastatic melanoma. Participants randomised: 93.
Interventions	Two‐arm trial: Biochemotherapy: cisplatin 30 mg/m² IV days 1 to 3, dacarbazine 250 mg/m² IV days 1 to 3, IFN‐α 10 mU/m² days 1 to 5 SC, and IL‐2 IV 1 mg/m² /6 h day 4, 1 mg/m² /12 h/day 5, 1 mg/m² /24 h day 6, 0.25 mg/m² / 24 h days 7 to 9 every 4 weeks for a maximum of 4 cycles (N = 45); Chemotherapy followed by biochemotherapy: dacarbazine 850 mg/m² IV days 1 and 22 followed by cisplatin 30 mg/m² IV days 1 to 3, dacarbazine 250 mg/m² IV days 1 to 3, IFN‐α 10 mU/m² days 1 to 5 SC, and IL‐2 IV 1 mg/m² /6 h day 4, 1 mg/m² /12 h/day 5, 1 mg/m² /24 h day 6, 0.25 mg/m² / 24 h days 7 to 9 every 4 weeks for a maximum of 4 cycles (N = 44).
Outcomes	Progression‐free survival. Overall survival. Tumour response. Toxicity.
Notes	Cross‐over: not allowed. Quality of life: not reported. Participants with brain metastasis: excluded. Median follow‐up: not available.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Randomisation was performed centrally". Comment: There was insufficient information about the sequence generation process to permit judgment.
Allocation concealment (selection bias)	Unclear risk	There was insufficient information to permit judgment.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	As an open label study, no blinding of participants or personnel was possible. However, we believe that in this setting (metastatic melanoma), with the treatments tested and outcomes assessed, the knowledge of which intervention was received or administered (rather than the intervention itself), could not affect the outcomes under investigation. Therefore, we judged the risk of performance bias as low.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	There was insufficient information to permit judgment.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Missing outcome data were balanced across intervention groups, with similar reasons for missing data across groups.
Selective reporting (reporting bias)	Low risk	No differences between protocol and published report.
Other bias	Low risk	The study appeared to be free of other sources of bias.