This Article Full Text Full Text (PDF) All Versions of this Article: theoncologist.2009-0083v1 14/10/995    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Google Scholar Articles by Minor, D. R. Articles by O'Day, S. PubMed PubMed Citation Articles by Minor, D. R. Articles by O'Day, S.

Melanoma and Cutaneous Malignancies

Prognostic Factors in Metastatic Melanoma Patients Treated with Biochemotherapy and Maintenance Immunotherapy

^aCalifornia Pacific Medical Center, San Francisco Oncology Associates, San Francisco, California, USA; ^bThe Melanoma Center, University of California, San Francisco, California, USA; ^cThe Angeles Clinic and Research Institute, Santa Monica, California, USA

Key Words. Melanoma • Biochemotherapy • Immunotherapy • Interleukin-2

Correspondence: David R. Minor, M.D., California Pacific Medical Center, 2100 Webster Street, Suite 326, San Francisco, California 94115, USA. Telephone: 415-885-8600; Fax: 415-885-8680; e-mail: minord{at}sutterhealth.org

Received April 26, 2009; accepted for publication September 1, 2009; first published online in THE ONCOLOGIST Express on September 23, 2009.

Disclosures: David R. Minor: None; Dan Moore: None; Christine Kim: None; Mohammed Kashani-Sabet: Consultant/advisory role: Schering-Plough; Honoraria: Schering-Plough; Suraj S. Venna: None; Wei Wang: None; Peter Boasberg: None; Steven O'Day: Consultant/advisory role: Bristol-Myers Squibb, Synta; Honoraria: Bristol-Myers Squibb, Synta; Research funding/contracted research: Bristol-Myers Squibb, Synta.

The article discusses unlabeled use of temozolomide (Schering-Plough), cisplatin (various, generic), and vinblastine (various, generic).

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Background. With no U.S. Food and Drug Administration–approved standard therapy other than high-dose interleukin-2 and dacarbazine for metastatic melanoma, biochemotherapy has shown promise, with long-term survival in selected patients. We felt that the study of prognostic factors would determine which patients might benefit from this intensive therapy.

Methods. One hundred thirty-five consecutive patients with metastatic melanoma treated with decrescendo biochemotherapy followed by maintenance immunotherapy over 5 years were retrospectively studied to determine the most important prognostic factors for both overall survival and progression-free survival.

Results. The median overall survival (OS) time was 16.6 months, with 1-year and 5-year survival rates of 70% and 28%, respectively. The median progression-free survival (PFS) time was 7.6 months, with 15% of patients progression free at 5 years. PFS curves showed no relapses after 30 months, so remissions were durable. For OS, a performance status score of zero, normal lactate dehydrogenase (LDH) level, stage M1a, and nonvisceral sites of metastasis were favorable factors. The group with normal LDH levels and skin or nodes as one of their metastatic sites had a relatively good prognosis, with median survival time of 44 months and an estimated 5-year survival rate of 38%. Conversely, patients with an elevated LDH level without any skin or nodal metastases had a poor prognosis, with no long-term survivors.

Conclusions. Metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy who have either a normal LDH level or skin or nodes as one of their metastatic sites may have durable remissions of their disease, and this therapy should be studied further in these groups.