Tessier M H, Mansat E, Legoux B, Litoux P, Dreno B
Clinique Dermatologique, CHU Hôtel-Dieu, Nantes.
Ann Dermatol Venereol. 1996;123(9):538-42.
The aim of this work was to study the effectiveness and safety of a combined therapy with dacarbazine, cisplatin and interferon alpha in the treatment of metastatic melanoma.
Sixteen patients, including 15 with one or more visceral metastases, were treated with dacarbazin 400 mg/m2, cisplatin 100 mg/m2 repeated every 28-day and interferon alpha-2a 3.10(6) IU subcutaneously 3 times weekly. Fifty percent of patients had at least 3 different sites of metastases. Ten patients had previously received one or more specific treatment for their melanoma.
The overall response was 25 p. 100 (2 complete responses and 2 partial responses). The two complete responses were obtained on liver, lung and cutaneous metastases and remain in sustained, unmaintained remission for 22 and 24 months. Administration of this treatment was well tolerated, the most prevalent toxicity being hematologic. At present, responding patients have a median survival of 26 months+ since the beginning of the treatment, compared to 7 months for non responding patients.
Dacarbazine and cisplatin combined chemotherapy has been used at various doses with an overall response rate of 14 to 37 p. 100, similar to our results. However, duration of complete response in our study (22 months+ and 24 months+) seem more prolonged than in studies using dacarbazine and cisplatin at dose of 100 mg/m2/21 d (7 to 9 months) and comparable to studies using dacarbazine and cisplatin at dose of 150 mg/m2/28 d or more (15 months+ to 19 months+ and 24 months+) but with less toxicity. Therefore addition of interferon alpha might be of interest in the maintain of complete remissions and perhaps in the prolongation of survival of responding patients as it has already been suggested with the dacarbazine-interferon alpha combination.
本研究旨在探讨达卡巴嗪、顺铂和α干扰素联合治疗转移性黑色素瘤的有效性和安全性。
16例患者，其中15例有一处或多处内脏转移，接受达卡巴嗪400mg/m²、顺铂100mg/m²，每28天重复一次，以及α干扰素-2a 3×10⁶IU皮下注射，每周3次。50%的患者至少有3个不同部位的转移灶。10例患者此前已接受过一种或多种针对其黑色素瘤的特异性治疗。
总体缓解率为25%（2例完全缓解和2例部分缓解）。2例完全缓解分别出现在肝脏、肺部和皮肤转移灶，持续未维持缓解状态达22个月和24个月。该治疗耐受性良好，最常见的毒性为血液学毒性。目前，缓解患者自治疗开始后的中位生存期为26个月以上，而未缓解患者为7个月。
达卡巴嗪和顺铂联合化疗已在不同剂量下使用，总体缓解率为14%至37%，与我们的结果相似。然而，我们研究中完全缓解的持续时间（22个月以上和24个月以上）似乎比使用100mg/m²/21天剂量的达卡巴嗪和顺铂的研究（7至9个月）更长，与使用150mg/m²/28天或更高剂量的达卡巴嗪和顺铂的研究（15个月以上至19个月以上和24个月以上）相当，但毒性较小。因此，添加α干扰素可能有助于维持完全缓解，或许还能延长缓解患者的生存期，正如之前达卡巴嗪与α干扰素联合使用时所表明的那样。
