Combination cytotoxic chemotherapy with procarbazine, vincristine, and lomustine (POC) in disseminated malignant melanoma: 8 years' follow-up.

Forty-four consecutive ambulatory patients (24 male, 20 female; median age, 56 years [range, 21-76]) with evaluable disseminated malignant melanoma (stages III/IV) were entered in this study from October 1, 1975, to July 21, 1980 (last follow-up, October 31, 1983); they were treated with procarbazine (100 mg/,m2 orally; maximum dose, 150 mg) on Days 1-10, vincristine (1.4 mg/m2 iv; maximum dose, 2 mg) on Days 1 and 8, and lomustine (150 mg/m2 orally; maximum dose, 200 mg) on Day 1, repeated every 4-6 weeks. Twenty-one patients (48%) showed objective responses; 11 of these (25%) were complete responses. Nine patients had received previous chemotherapy, but none were treated with the drugs used in this protocol. Responses were seen mainly in cutaneous and/or nodal sites and pulmonary metastases. The median duration of remission was 10 months and the median survival of responders was 21 months compared to 5 months for nonresponders. Four responding patients are still alive and in complete response for 70+, 83+, 94+, and 95+ months, while one is alive, but in progression (83+ months). The toxicity of this regimen was clinically tolerable and hospitalization was not required. In our initial study the response rate was 60% (18 responses among 30 patients) and this regimen continues to have significant antitumor activity against disseminated malignant melanoma.