Dacarbazine (DTIC)-based chemotherapy or chemoimmunotherapy of patients with disseminated malignant melanoma

Smman- Combinations of dacarbazine (DTIC) and other cytotoxic agents or alpha-interferon were given to 136 patients in five different regimens. The total response rate was 32%o (95 % confidence interval 24-400 o): 13 % had a complete remission. Female patients had a significantly higher chance of response than male patients: 46 % vs 23%. There was also a difference in complete response rate: 25 % vs 9%O. The overall survival was 6 months: 8 % of patients had a response of more than 6 months and 2 % of more than 2 years. Although response rates vary among the various regimens described in the literature. the complete response rates are quite similar and the long-term disease-free survival of these combinations mav be similar to that of dacarbazine alone. Treatment of patients with disseminated malignant melanoma remains unsatisfactory. Options under study in-clude no treatment. biological therapy. chemotherapy or combinations of both. Often short-term evaluations. focusing only on response rates. are used to direct further studies or to influence treat-ment outside the clinical trial situation. However, as re-sponses are usually short-lived and occur in non-symptomatic lesions, they are unlikely to have much influence on survival or on quality of life. For many years dacarbazine (DTIC) has been the mainstay of chemotherapy in this stage of disease. mainly because of the lack of demonstrated superiority of any other agent or combination. We have over a 7 year period used this drug as part of various combination regimens in 136 consecutive patients with disseminated malignant melanoma (Mulder et al.. 1986