PALA, vindesine, and cisplatin combination chemotherapy in advanced malignant melanoma. A pilot study
PALA, vindesine, and cisplatin combination chemotherapy in advanced malignant melanoma. A pilot study
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PALA、长春地辛和顺铂联合化疗治疗晚期恶性黑色素瘤。
作者：
H. Voigt;U. Kleeberg
22例晚期恶性黑色素瘤患者进入了一项先导研究，接受PALA、长春地西和顺铂（PVP）联合化疗。治疗方法为：PALA 3000 mg/m2 IV（第1、2天），长春地辛3 mg/m2 IV（第1、8天），顺铂30 mg/m2 IV（第1 ~ 5天），每3周第21天重复治疗周期。在22例患者中，3例患有局限于外区域肿瘤生长的非内脏疾病（III期），19例患有弥散性和/或内脏疾病（IV期）。男女性别分布为13/9；中位年龄为45岁。所有22例患者均有可测量的疾病；21例可评价反应和毒性。5例患者（24%）有完全缓解（CR），中位持续时间为5个月，4例患者（19%）有部分缓解（PR），中位持续时间为3个月。7例患者病情稳定（33%），中位病程2个月。进行性疾病见于5例（24%），通常是由于广泛的内脏疾病。CR主要见于非内脏疾病，而PR也见于内脏疾病。从PVP化疗开始的生存时间最终无法估计，因为目前一些反应仍在继续，21例患者中有7例仍然存活。目前，应答者的中位生存时间为8个月，无应答者为5个月。PVP化疗的毒性为轻度至中度，允许在门诊基础上使用细胞毒性药物。PVP化疗似乎对恶性黑色素瘤有显著的活性，因此可能是治疗晚期疾病的一种替代方案。然而，尽管缓解率相对较高，特别是在非内脏疾病中，但反应持续时间仍然很低。
Twenty‐two patients with advanced malignant melanoma were entered in a pilot study receiving combination chemotherapy with PALA, vindesine, and cisplatin (PVP). Treatment consisted of PALA 3000 mg/m2 IV on days 1 and 2, vindesine 3 mg/m2 IV on days 1 and 8, cisplatin 30 mg/m2 IV on days 1 through 5, with treatment cycles repeated on day 21 every 3 weeks. Of 22 patients, 3 had non‐visceral disease confined to iuxtaregional tumor growth (Stage III), and 19 had disseminated and/or visceral disease (Stage IV). The male/female sex distribution was 13/9; median age was 45 years. All 22 patients had measurable disease; 21 were evaluable for response and toxicity. Five patients (24%) had a complete response (CR) with a median duration of 5 months, and four patients (19%) had a partial response (PR) with a median duration of 3 months. Seven patients showed disease stabilization (33%) with a median duration of 2 months. Progressive disease was seen in five patients (24%) and was commonly due to widespread visceral disease. CR could be found predominantly in non‐visceral disease, whereas PR could be observed in visceral disease also. Survival time from the onset of PVP chemotherapy cannot be estimated finally, since some of the responses are continuing at the present time, and 7 of 21 patients are still alive. Currently, median survival time for responders is 8 months, and for nonresponders, 5 months. Toxicity of PVP chemotherapy is mild to moderate and allows cytotoxic drug administration on an outpatient basis. PVP chemotherapy appears to have significant activity against malignant melanoma and may therefore be an alternative regimen in the management of advanced disease. However, despite the relative high remission rate especially in non‐visceral disease, response duration remains disappointingly low.