Biochemotherapy of metastatic melanoma in patients with or without recently diagnosed brain metastases

Martin Majer, Randy L. Jensen, Dennis C. Shrieve, Gordon A. Watson, Michael Wang, Sancy Leachman, Kenneth M. Boucher, Wolfram E. Samlowski

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

BACKGROUND. Brain metastases are an alarming complication of advanced melanoma, frequently contributing to patient demise. The authors performed a retrospective analysis to determine whether the treatment of metastatic melanoma with biochemotherapy would result in similar outcomes if brain metastases were first controlled with aggressive, central nervous system (CNS)-directed treatment. METHODS. Seventy melanoma patients were treated with biochemotherapy for metastatic melanoma between 1999 and 2005. Of these, 20 patients had recently diagnosed brain metastases, whereas 50 did not. Brain metastases (if present) were treated with stereotactic radiosurgery ≥28 days prior to systemic therapy. All patients were treated with biochemotherapy consisting of either dacarbazine or temozolomide in combination with a 96-hour continuous intravenous infusion of interleukin-2 and subcutaneous interferon-α-2B. The primary endpoint was survival from the time of the initial diagnosis of metastatic disease. RESULTS. Median survival from the time of the diagnosis of metastatic melanoma was 15.8 months for patients with brain metastases and 11.1 months for those without CNS involvement (P = .26 by the log-rank test; P = .075 by the Gehan Wilcoxon test). Dacarbazine-based and temozolomide-based regimens appeared similar with regard to their effect on overall survival and CNS disease progression. A plateau in further brain recurrences was observed in patients who survived for >20 months. CONCLUSIONS. Data from the current study suggest that the outcome of biochemotherapy is comparable in patients with and those without brain metastases, if brain metastases are controlled with multidisciplinary treatment. Prolonged survival can be achieved in approximately 15% of patients, regardless of whether or not brain metastases are present.

Original languageEnglish (US)
Pages (from-to)1329-1337
Number of pages9
JournalCancer
Volume110
Issue number6
DOIs
StatePublished - Sep 15 2007
Externally publishedYes

Fingerprint

Melanoma
Neoplasm Metastasis
Brain
temozolomide
Dacarbazine
Survival
Central Nervous System
Radiosurgery
Central Nervous System Diseases
Therapeutics
Intravenous Infusions
Interferons
Interleukin-2
Disease Progression
Outcome Assessment (Health Care)
Recurrence

Keywords

  • Biochemotherapy
  • Brain metastases
  • Malignant melanoma
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Majer, M., Jensen, R. L., Shrieve, D. C., Watson, G. A., Wang, M., Leachman, S., ... Samlowski, W. E. (2007). Biochemotherapy of metastatic melanoma in patients with or without recently diagnosed brain metastases. Cancer, 110(6), 1329-1337. https://doi.org/10.1002/cncr.22905

Biochemotherapy of metastatic melanoma in patients with or without recently diagnosed brain metastases. / Majer, Martin; Jensen, Randy L.; Shrieve, Dennis C.; Watson, Gordon A.; Wang, Michael; Leachman, Sancy; Boucher, Kenneth M.; Samlowski, Wolfram E.

In: Cancer, Vol. 110, No. 6, 15.09.2007, p. 1329-1337.

Research output: Contribution to journalArticle

Majer, M, Jensen, RL, Shrieve, DC, Watson, GA, Wang, M, Leachman, S, Boucher, KM & Samlowski, WE 2007, 'Biochemotherapy of metastatic melanoma in patients with or without recently diagnosed brain metastases', Cancer, vol. 110, no. 6, pp. 1329-1337. https://doi.org/10.1002/cncr.22905
Majer, Martin ; Jensen, Randy L. ; Shrieve, Dennis C. ; Watson, Gordon A. ; Wang, Michael ; Leachman, Sancy ; Boucher, Kenneth M. ; Samlowski, Wolfram E. / Biochemotherapy of metastatic melanoma in patients with or without recently diagnosed brain metastases. In: Cancer. 2007 ; Vol. 110, No. 6. pp. 1329-1337.
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AB - BACKGROUND. Brain metastases are an alarming complication of advanced melanoma, frequently contributing to patient demise. The authors performed a retrospective analysis to determine whether the treatment of metastatic melanoma with biochemotherapy would result in similar outcomes if brain metastases were first controlled with aggressive, central nervous system (CNS)-directed treatment. METHODS. Seventy melanoma patients were treated with biochemotherapy for metastatic melanoma between 1999 and 2005. Of these, 20 patients had recently diagnosed brain metastases, whereas 50 did not. Brain metastases (if present) were treated with stereotactic radiosurgery ≥28 days prior to systemic therapy. All patients were treated with biochemotherapy consisting of either dacarbazine or temozolomide in combination with a 96-hour continuous intravenous infusion of interleukin-2 and subcutaneous interferon-α-2B. The primary endpoint was survival from the time of the initial diagnosis of metastatic disease. RESULTS. Median survival from the time of the diagnosis of metastatic melanoma was 15.8 months for patients with brain metastases and 11.1 months for those without CNS involvement (P = .26 by the log-rank test; P = .075 by the Gehan Wilcoxon test). Dacarbazine-based and temozolomide-based regimens appeared similar with regard to their effect on overall survival and CNS disease progression. A plateau in further brain recurrences was observed in patients who survived for >20 months. CONCLUSIONS. Data from the current study suggest that the outcome of biochemotherapy is comparable in patients with and those without brain metastases, if brain metastases are controlled with multidisciplinary treatment. Prolonged survival can be achieved in approximately 15% of patients, regardless of whether or not brain metastases are present.

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