Combination chemotherapy of malignant melanoma with imidazole carboxamide, BCNU and vincristine

Regional treatment of hepatic metastases and hepatocellular carcinoma

Hepatic metastases represent a common site of dissemination for a number of primary malignancies related in part to the dual blood supply, large blood flow, and receptive environment of the hepatic parenchyma. Although this review focuses on regional therapy, we have included sections on systemic therapy to better interpret the results with intrahepatic therapy. We will also discuss the efficiency of hepatic arterial ligation, embolization, and radiotherapy of hepatic metastases. Primary gastrointestinal neoplasms are particularly prone to produce hepatic metastases. Because colorectal carcinoma metastasizes to the liver in up to 70% of patients with advanced disease, the treatment of hepatic metastases is a relevant topic. We will discuss the systemic and regional therapy of colorectal, gastric, and gallbladder cancers. Breast carcinoma and malignant melanoma frequently metastasize to the liver, and we have described systemic and regional treatments of these diseases. Because sarcomas are often treated by regional therapy, we have included a section on the treatment of hepatic sarcomas. Neuroendocrine tumors (carcinoid and islet cell), although often slow growing, frequently metastasize to the liver and then cause symptomatic problems. Much of the work done with embolization and hepatic ligation in the treatment of hepatic metastases has been performed in neuroendocrine tumors, and these studies, as well as the systemic and regional chemotherapy of hepatic metastases, will be described. The last section concerns the treatment of hepatocellular carcinoma. We have outlined the staging systems used. We then detail the results of systemic and intrahepatic therapy, embolization, and hepatic ligation in the treatment of hepatocellular carcinoma. Because hepatic metastases are a frequent problem, many patients are available for clinical investigation. It is hoped that newer strategies for the treatment of liver metastases will lead to higher response rates and perhaps control of local disease. These therapeutic approaches may also give us leads to the treatment of systemic disease.

Management of malignant melanoma: a retrospective analysis of 182 patients

The records of 182 patients, referred to the Regional Radiotherapy Centre, Newcastle upon Tyne between January 1975 and December 1980, have been reviewed to evaluate the results of different modes of treatment. Fifty-two patients were managed for Stage 1, 83 for Stage 2 and 47 for Stage 3 disease. Fifty-seven patients with 95 sites of disease were given chemotherapy. The overall response rate was 35% (complete response (CR) 14%, partial response (PR) 21%) (median duration of remission = 4 months). Sixty-three patients with 74 sites of disease were treated by radiotherapy. The overall response rate was 73% (CR 47%, PR 26%) (median duration of remission = 7 months). In Stage 2 disease, no significant difference in the disease-free or overall survival was found between four different treatment groups. In disseminated disease, chemotherapy had little impact on the survival of patients with visceral metastases, while those with skin and lymph node metastases had significantly better survival. Radiotherapy was tolerated better and had lower morbidity than chemotherapy. The role of both modes in the management of advanced disease is discussed.

A trial of imidazole carboxamide and corynebacterium parvum in disseminated melanoma: clinical and immunologic results

Nonspecific immunotherapy with monthly intramuscular (IM) injections of Corynebacterium parvum has been investigated in patients with disseminated melanoma. Forty-nine patients were randomized to receive either imidazole carboxamide (DTIC) alone or DTIC plus C parvum. A 24% overall objective response rate was observed, with no significant difference between the response rate or survival of the two treatment groups. Immunologic studies revealed no significant difference between the two groups. One patient undergoing chemoimmunotherapy demonstrated profound pancytopenia which responded to cessation of therapy, but toxic reactions were otherwise minimal. No advantage was obtained by adding IM injected C parvum to standard chemotherapy in the treatment of disseminated melanoma.

Chemotherapy of unresectable or recurrent metastatic malignant melanomas: an update

Satisfactory chemotherapeutic management of malignant melanomas in advanced stages must await development of more active agents and combinations of them than are presently available. The development of entirely new means of treatment by hormones, heat, and adjuvants like amphotericin B may improve the efficacy of currently available agents.

Chemoimmunotherapy in disseminated melanoma and colorectal carcinoma

Non-specific immunotherapy with monthly intramuscular injection of Corynebacterium parvum has been investigated by randomized clinical trials in patients with advanced cancer. Thirty-six patients with disseminated melanoma were treated with either imidazole carboxamide (DTIC) alone or DTIC plus C.parvum. A 19% objective response rate was observed. The mean survival time was similar for both groups. Thirty-three patients with disseminated colorectal cancer were treated with either 5-fluorouracil (5FU) alone or 5FU plus C.parvum. No objective responses were observed. The mean survival time was similar for both groups. No advantage has been demonstrated in either tumour group by adding C.parvum to standard chemotherapy.

Combination chemotherapy in metastatic malignant melanoma: a randomized study of three DTIC-containing combination

The activity of three DTIC-containing combinations was compared in a prospective randomized study. Of 101 patients randomized to receive one of the three regimens, 95 received adequate trials. Response rates were as follows: DTIC + cyclophosphamide 7/29 (24%); DTIC + vinblastine 6/34 (18%); DTIC + procarbazine 4/32 (13%). None of these response rates is significantly superior to any of the others. When the activity of the combination is analyzed by sex, DTIC + cyclophosphamide appears more active in females than the other regimens, but the difference is not statistically significant. Response to treatment is associated with significant prolongation of life; the median survival among responders was 11 months, while those who progressed lived a median of 4 months from the start of therapy. Toxicity of all regimens appeared to be about the same; therapy with DTIC + procarbazine was associated with significantly more nausea and vomiting. This study has failed to demonstrate clearly that any of three combinations is superior to any of the others.

Actual doubling time values of pulmonary metastases from malignant melanoma

The growth rate of pulmonary metastases was determined in 18 patients with pulmonary metastases from histologically proven malignant melanoma. From chest radiograms 81 metastases were measured 51 consecutive times, and 120 values for doubling time were obtained. metastases with diameters of 15.0 mm or less grew significantly faster (arithmetic mean=24.9 days) than metastases with diameters over 15.0 mm (arithmetic mean=51.0 days). The difference is statistically significant (P less than 0.050). In about one-tenth (9.2%) of all measurements the values for doubling time are considerably lengthened (arithmetic mean=182.2 days). The determination of doubling time values may be considered as a useful parameter in the selection of patients for treatment of pulmonary metastases from malignant melanoma.