Sj. O'Day et al., Advantages of concurrent biochemotherapy modified by decrescendo interleukin-2, granulocyte colony-stimulating factor, and tamoxifen for patients with metastatic melanoma, J CL ONCOL, 17(9), 1999, pp. 2752-2761
Purpose: Concurrent biochemotherapy results in high response rates but also
significant toxicity in patients with metastatic melanoma. We attempted ta
improve its efficacy and decrease its toxicity by using decrescendo dosing
of interleukin-2 (IL-2), posttreatment granulocyte colony-stimulating fact
or (G-CSF), and low-dose tamoxifen.
Patients and Methods: Forty-five patients with poor prognosis metastatic me
lanoma were treated at a community hospital inpatient oncology unit affilia
ted with the John Wayne Cancer Institute (Santa Monica, CA) between July 19
95 and September 1997. A 5-day modified concurrent biochemotherapy regimen
of dacarbazine, vinblastine, cisplatin, decrescendo IL-2, interferon alfa-2
b, and tamoxifen was repeated at 21-day intervals. G-CSF was administered b
eginning on day 6 for 7 to 10 days.
Results: The overall response rate war 57% (95% confidence interval, 42% to
72%), the complete response rate was 23%, and the partial response rate wa
s 34%. Complete remissions were achieved in an additional 11% of patients b
y surgical resection of residual disease after biochemotherapy. The median
time to progression was 6.3 months and the median duration of survival was
11.4 months. At a maximum follow-up of 36 months (range, 10 to 36 months),
32% of patients are alive and 14% remain free of disease. Decrescendo IL-2
dosing and administration of G-CSF seemed to reduce toxicity, length of hos
pital stay, and readmission rates. No patient required intensive care unit
monitoring, and there were no treatment-related deaths.
Conclusion: The data from this study indicate that the modified concurrent
biochemotherapy regimen reduces the toxicity of concurrent biochemotherapy
with no apparent decrease in response rate in patients with poor prognosis
metastatic melanoma. (C) 1999 by American Society of Clinical Oncology.