title: A phase II study of bosentan, a dual endothelin receptor antagonist, as monotherapy in patients with stage IV metastatic melanoma.
abstract: There is no effective systemic therapy for disseminated metastatic melanoma. Data suggest that endothelin may play a role in pathophysiology of melanoma and that the dual endothelin receptor antagonist bosentan may have anti-tumor activity. This multicenter, open-label, single-arm, prospective, proof-of-concept study assessed the effects of bosentan monotherapy (500 mg oral tablets, bid) on tumor response in patients with stage IV metastatic melanoma. Patients were treated until disease progression, death or serious adverse event leading to premature study drug discontinuation. Tumor response was assessed at 6-weekly intervals using the Response Evaluation Criteria in Solid Tumors (RECIST). Among the 35 patients included in this study with stage IV metastatic melanoma, 21 (60%) were stage M1C, 10 (29%) stage M1B and 4 (11%) stage M1A (American Joint Committee on Cancer [AJCC] classification). Nine patients (26%) had received prior therapy for stage IV melanoma. Disease stabilization was observed in 6 of the 32 patients analyzed per protocol at week 6 with confirmatory evaluation at week 12, 5 of whom were still stable at > or =24 weeks. Of the 6 patients with disease stabilization, 2 were stage M1A, 1 was stage M1B and the remaining 3 were stage M1C. Partial or complete response was not observed. Progressive disease was observed in 17 (49%) patients at week 12 and in 25 (71%) patients at the end of the study (data base closure). The most frequent adverse events were typical for the underlying disease or known to be associated with bosentan: headache (43%), fatigue (34%), nausea (31%), back pain (23%) and abnormal hepatic function (23%). Bosentan might have benefit in disease stabilization in certain patients with metastatic melanoma and deserves further investigation in combination with other anticancer drugs.
authors.affiliation: Actelion Pharmaceuticals Ltd., Allschwil, Switzerland. rick_kefford@wmi.usyd.edu.au
authors.forename: Richard
authors.initials: R
authors.lastname: Kefford
authors.forename: Jane McNeil
authors.initials: JM
authors.lastname: Beith
authors.forename: Guy Arthur
authors.initials: GA
authors.lastname: Van Hazel
authors.forename: Michael
authors.initials: M
authors.lastname: Millward
authors.forename: James Marshall
authors.initials: JM
authors.lastname: Trotter
authors.forename: David Keith
authors.initials: DK
authors.lastname: Wyld
authors.forename: Rada
authors.initials: R
authors.lastname: Kusic
authors.forename: Revati
authors.initials: R
authors.lastname: Shreeniwas
authors.forename: Adele
authors.initials: A
authors.lastname: Morganti
authors.forename: Andrea
authors.initials: A
authors.lastname: Ballmer
authors.forename: Eleonor
authors.initials: E
authors.lastname: Segal
authors.forename: Oliver
authors.initials: O
authors.lastname: Nayler
authors.forename: Martine
authors.initials: M
authors.lastname: Clozel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D000077300:Bosentan; D065128:Endothelin Receptor Antagonists; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism / Q000556:secondary; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012333:RNA, Messenger / Q000378:metabolism; D017466:Receptors, Endothelin / Q000235:genetics / Q000378:metabolism; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013607:Tablets; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D065128:Endothelin Receptor Antagonists; D012333:RNA, Messenger; D017466:Receptors, Endothelin; D013449:Sulfonamides; D013607:Tablets; D000077300:Bosentan