Cohort study of metastatic melanoma patients in the Dermatology Institute of Florence 1990/1997

Background Chemotherapy and immunotherapy are treatments currently employed in advanced melanoma, but responses obtained are poor, and metastatic mela noma patients with visceral localization rarely survive for more than 6 mon ths. Thus, different therapeutic regimens are used in metastatic melanoma a nd no standardized therapy exists so far. Methods We report a retrospective survival study involving 80 patients with metastatic melanoma who were treated either with chemotherapy [dacarbazine (DTIC) alone or DTIC in monotherapeutic or polychemotherapeutic regimen] o r immunochemotherapy [interferon (IFN)-alpha at low doses added to chemothe rapy]. Survival of patients was statistically evaluated in an actuarial cur ve taking into account as predictive variables sex, age, marital status, si te of primary tumour, histological type, Clark level, sites of metastases, and the different therapeutic regimens (i.e. DTIC alone, DTIC plus IFN-alph a, or others, with or without IFN-alpha). Results Site of primary melanoma, histological type, Clark level and therap y regimen appeared to exhibit a prognostic significance in survival; when a multivariate analysis was performed to obtain a mutual adjustment of survi val values for each variable, only the therapeutic regimen was found to be significant as an independent prognostic variable. Patients treated with im munochemotherapy, i.e. DTIC plus IFN-alpha, showed a probability of dying o f 0.41 (95% confidence interval 0.2-0.8) compared with patients treated wit h DTIC alone. Conclusions In our study immunochemotherapy, comprised of DTIC plus IFN-alp ha at low doses, was associated with a significantly longer survival of pat ients, in comparison with chemotherapy comprised of only DTIC.