Advantages of concurrent biochemotherapy modified by decrescendo interleukin-2, granulocyte colony-stimulating factor, and tamoxifen for patients with metastatic melanoma

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.