Vinblastin-carboplatin for metastatic cutaneous melanoma as first-line chemotherapy and in dacarbazine failures - A single-center study

First-line treatments of metastatic melanoma are usually decarbazine (DTIC) and/or alpha -interferon based, with response rates in the range of at mos t 20-30%. In this study, initiated, in fact, by a temporary DTIC shortage i n the country, we have assessed the efficacy and toxicity of a vinblastine - carboplatin regimen for metastatic melanoma. The regimen was subsequently applied in two cohorts of patients: a chemotherapy-naive one and in DTIC f ailures (because the regimen was claimed non-cross-resistant). The regimen contained 6 mg/m(2) vinblastine on d 1 and 450 mg/m(2) carboplatin on d 1 f or 3 wk. In the chemotherapy-naive cohort, 50 patients were included, 29 ma les and 21 females, median age 54 yr (range: 33-68), performance status 0+1 for 26 patients and 2+3 for 24 patients. Forty-eight patients were evaluab le for activity. The response was the following: complete response (CR), 1/ 48 (2%); partial response (PR), 13/48 (27%); stable disease (SD), 20/48 (42 %); progressive disease (PD), 14/48 (29%). The overall response rate was 14 /48 (29%). The median response duration was 7 mo (range: 3-14); the median time to progression was 4 mo (range: 2-14). Toxicity included granulocytope nia and thrombocytopenia grade IV in 3/50 patients and nausea grade II in 8 /50 patients. In the DTIC-failures cohort, 58 patients were included, 38 ma les and 20 females, median age 51 yr (range: 20-65), performance status 0+1 for 25 patients and 2+3 for 33 patients. All 58 patients were evaluable fo r activity. The response was the following: CR 3/58 (5%), PR 4/58 (7%), SD 10/58 (17%), PD 41/58 (71%). The overall response rate was 7/58 (12%). The median response duration was 11 mo (range: 3-24); the median time to progre ssion was 4 mo (range: 2-24). Toxicities included granulocytopenia grade IV in 4/58 patients and nausea grade II in 4/58 patients. Thus, despite the f act that the regimen achieved a response rate comparable to DTIC in a first -line setting, the lack of cross-resistance did not prevent it from being o f limited activity in DTIC failures, although, even in this group, several long-lasting responses and stabilizations were noted.