title: A phase I-II study of the histone deacetylase inhibitor valproic acid plus chemoimmunotherapy in patients with advanced melanoma.
abstract: We explored in a phase I/II clinical trial the combination of valproic acid (VPA), a clinically available histone deacetylase inhibitor, with standard chemoimmunotherapy in patients with advanced melanoma, to evaluate its clinical activity, to correlate the clinical response with the biological activity of VPA and to assess toxicity. Patients were treated initially with VPA alone for 6 weeks. The inhibition of the target in non-tumour peripheral blood cells (taken as a potential surrogate marker) was measured periodically, and valproate dosing adjusted with the attempt to reach a measurable inhibition. After the treatment with valproate alone, dacarbazine plus interferon-alpha was started in combination with valproate. Twenty-nine eligible patients started taking valproate and 18 received chemoimmunotherapy and are assessable for response. We observed one complete response, two partial remissions and three disease stabilisations lasting longer than 24 weeks. With the higher valproate dosages needed to reach a measurable inhibition of the target, we observed an increase of side effects in those patients who received chemoimmunotherapy. The combination of VPA and chemoimmunotherapy did not produce results overtly superior to standard therapy in patients with advanced melanoma and toxicity was not negligible, casting some doubts on the clinical use of VPA in this setting (at least in the administration schedule adopted).
authors.affiliation: Department of Medicine, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy. a.rocca@irst.emr.it
authors.forename: A
authors.initials: A
authors.lastname: Rocca
authors.forename: S
authors.initials: S
authors.lastname: Minucci
authors.forename: G
authors.initials: G
authors.lastname: Tosti
authors.forename: D
authors.initials: D
authors.lastname: Croci
authors.forename: F
authors.initials: F
authors.lastname: Contegno
authors.forename: M
authors.initials: M
authors.lastname: Ballarini
authors.forename: F
authors.initials: F
authors.lastname: Nolè
authors.forename: E
authors.initials: E
authors.lastname: Munzone
authors.forename: A
authors.initials: A
authors.lastname: Salmaggi
authors.forename: A
authors.initials: A
authors.lastname: Goldhirsch
authors.forename: P G
authors.initials: PG
authors.lastname: Pelicci
authors.forename: A
authors.initials: A
authors.lastname: Testori
mesh_terms: D000328:Adult; D000368:Aged; D003606:Dacarbazine / Q000008:administration & dosage*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D056572:Histone Deacetylase Inhibitors; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008545:Melanoma / Q000188:drug therapy*; D008875:Middle Aged; D014635:Valproic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood
chemical_list: D004791:Enzyme Inhibitors; D056572:Histone Deacetylase Inhibitors; D016898:Interferon-alpha; D014635:Valproic Acid; D003606:Dacarbazine