title: The effect of tamoxifen and cisplatin on the disease-free and overall survival of patients with high risk malignant melanoma.
abstract: The adjuvant treatment of high-risk malignant melanoma remains problematic. Previously we reported moderate success in the treatment of metastatic disease using tamoxifen, cisplatin, dacarbazine and carmustine. Based upon data that suggested tamoxifen and cisplatin were the active agents in this regimen, we initiated a phase II trial of this combination in the adjuvant setting. We treated 153 patients with 4 cycles of tamoxifen (160 mg day(-1), days 1-7) and cisplatin (100 mg m(-2), day 2) for 28-day intervals. Patients received an anti-nausea regimen of dexamethasone with ondansetron or granisetron. During the first 2 years of follow-up, patients were evaluated every 2 months with a history, physical exam, laboratory work and computed tomography scans of the chest, abdomen and pelvis every 4 months. Thereafter, patients were evaluated every 3 months and radiographic studies were performed if necessary. Currently, with a median follow-up of 36 months, the disease-free survival (DFS) is 68.4% and overall survival (OS) is 84.5%. Kaplan-Meier analysis predicts a 5-year DFS of 62% with an OS of 79%. Relapses after 20 months have been rare. No effect of gender or number of positive lymph nodes was noted, however, stage of disease prior treatment was a factor. The major toxicity proved to be gastrointestinal in nature with nausea the most prevalent symptom. Minimal renal, haematologic and neurologic toxicity occurred. These preliminary results suggest that there is a positive impact of tamoxifen and cisplatin on both the DFS and OS of high-risk malignant melanoma patients. The 5-year projected DFS and OS compare favourably with those reported for the ECOG 1684 trial and warrant confirmation in a prospective randomized trial.
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla 92093-0063, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: McClay
authors.forename: M E
authors.initials: ME
authors.lastname: McClay
authors.forename: L
authors.initials: L
authors.lastname: Monroe
authors.forename: P L
authors.initials: PL
authors.lastname: Baron
authors.forename: D J
authors.initials: DJ
authors.lastname: Cole
authors.forename: P H
authors.initials: PH
authors.lastname: O'Brien
authors.forename: J S
authors.initials: JS
authors.lastname: Metcalf
authors.forename: J C
authors.initials: JC
authors.lastname: Maize
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017829:Granisetron / Q000627:therapeutic use; D006801:Humans; D015993:Life Tables; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D017294:Ondansetron / Q000627:therapeutic use; D011379:Prognosis; D012306:Risk; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control
chemical_list: D000932:Antiemetics; D002945:Cisplatin; D003907:Dexamethasone; D017829:Granisetron; D017294:Ondansetron; D013629:Tamoxifen