Long-term outcome of treatment with dacarbazine, cisplatin, interferon-alpha and intravenous high dose interleukin-2 in poor risk melanoma patients

Melanoma patients with very advanced disease are usually excluded from chem oimmunotherapy trials; however, the efficacy of intensive treatment regimen s needs to be established for this patient population. This study aimed to evaluate the response rate and survival achieved with chemoimmunotherapy in very advanced melanoma patients. Forty-two patients received dacarbazine ( 250 mg/m(2), days 1-3), cisplatin (30 mg/m(2), days 1-3), interferon-alpha (10 Mio IU/m(2) subcutaneously, days 1-5) and intravenous interleukin-2 (18 Mio IU/m(2) over 6 h, 12 h then 24 h, followed by 13.5 Mio IU/m(2) in 72 h ). In cases of brain metastases (n = 12) radiation therapy was added. Ten p atients (24%) achieved a partial response, 11 (26%) had stable disease and 21 (50%) had disease progression in an intention-to-treat analysis. The med ian overall survival of patients with a partial response or stable disease was 9 months in contrast to 3.5 months in patients with disease progression . Normal serum lactate dehydrogenase before the start of treatment was a st rong favourable prognostic marker for survival (P < 0.002). We conclude tha t the described treatment schedule offers safe palliation in patients with very advanced metastatic melanoma. (C) 1998 Lippincott Williams & Wilkins.