ISOLATED LIMB PERFUSION WITH FOTEMUSTINE AFTER CHEMOSENSITIZATION WITH DACARBAZINE IN MELANOMA

Isolated limb perfusion (ILP) has been reported as the most effective treatment for localized recurrent melanoma of the limbs. In terms of l ocal and regional control with melphalan, complete remission is achiev ed in about 40% of patients, with frequent toxicity causing significan t short-term disability in many and long-term incapacity in a few. Sin ce 1989, several studies have reported success using a combination of fotemustine and dacarbazine (DTIC) in the systemic treatment of dissem inated melanoma and brain metastasis. In May 1995, we began a pilot st udy with systemic DTIC 400 mg/m(2) given intravenously about 4 h befor e ILP using fotemustine In an intra-arterial bolus of 100-150 mg/m(2) as the perfusion agent. By July 1996, 10 patients had been included in the study. The results were evaluated in terms of the response rate ( five complete responses and one partial response in the six patients w ho could be evaluated), local toxicity (nine patients with level I and one with level II, measured on the Wieberdink scale) and systemic tox icity (nine patients with level 0 and one with level 1, measured on th e World Health Organization scale). Treatment was effective, with a si milar response rate to that obtained with melphalan but with much lowe r toxicity, so this protocol may represent an innovation in loco-regio nal therapy and should be further investigated in a large trial.