The treatment of melanoma at Westminster Hospital in the 20th century

At Saint Dunstan's Coffee House in 1715 four London men met to form "A charitable proposal for Relieving the Poor and Needy and Other Distressed Persons". The proposal marked the beginnings of Westminster Hospital in London. Following the admission of the first patient in 1720, Westminster Hospital and later Westminster Medical School dominated the medical scene of London for over two and a half centuries until its closure in 1993 and transfer to the new Chelsea and Westminster Hospital. The Hospital and Medical school are credited with pioneering work in the fields of anaesthesia, immunology, bone marrow transplantation and the treatment of cancer. In the 20th century Westminster became a centre of tertiary referrals for cancer and under the leadership of Sir Stanford Cade and later of Gerald Westbury and Kenneth Newton the hospital pioneered the multidisciplinary management of malignant disease exemplified by the internationally- famous Wednesday afternoon clinics where the patients' best interests were discussed and served by a multitude of surgical and medical specialists. This paper focuses on the treatment of melanoma at Westminster Hospital in the 20th Century, placing in perspective the latest therapeutic developments based on the genetics of this cancer.

Progress but not enough: the 2009 (7th) revision of the American Joint Committee on Cancer (AJCC) for melanoma staging and classification

In 2009 the American Joint Committee on Cancer (AJCC) examined for the first time the mitotic rate of the primary melanoma as a new covariate in a revised staging and classification system. In a multifactorial analysis mitotic rate was the second most powerful predictor of survival after tumour thickness, reaffirming the findings of earlier studies. Analyses demonstrated a highly significant correlation between increasing mitotic rate and declining survival rates. Despite these findings some of the intrinsic weaknesses of the 2001 staging and classification system for melanoma remain apparent in the 7th revision of 2009 and are discussed in this paper.

The CDKN2A tumour suppressor gene: no mutations detected in patients with melanoma and additional unrelated cancers

Germ-line mutations of the CDKN2A tumour suppressor gene have been reported in association with familial melanoma, sporadic melanoma with multiple primary lesions and also pancreatic cancer. We studied the hypothesis that patients with melanoma and additional unrelated cancers may harbour mutations in the CDKN2A gene. Twenty seven patients with histologically confirmed melanoma who also had additional cancers such as breast, colorectal, lymphoma and other neoplasms were studied. We also examined 17 additional patients, 13 of whom had a first-degree relative with melanoma and four who had two or more primary melanomas. Some patients belonged to more than one of these categories. No mutations of the CDKN2A tumour suppressor gene were detected among patients with melanoma and additional cancers. The previously described Met53Ile CDKN2A mutation located in exon 2 was detected in a female patient with melanoma metastatic to the regional lymph nodes, multiple primary cutaneous lesions, atypical naevi and a first-degree relative with melanoma. The studied cohort is too small for firm conclusions. However, it would appear that melanoma and additional, apparently unrelated, cancers developing in the same individual are likely to be related to a combination of low-risk susceptibility genes and environmental factors.

Overexpression of HER-2 in thick melanoma

In this study we evaluated the overexpression status of HER-2 and its prognostic significance on survival in patients with thick cutaneous malignant melanoma. The immuno-alkaline phosphatase antigen detection technique was applied to archival diagnostic material from 51 patients with primary lesions measuring >or= 10 mm in Breslow thickness. Eleven additional patients with primary lesions measuring <or= 1 mm were also studied. HER-2 overexpression was evaluated using conventional light microscopy and an automated cellular imaging system (Chromavision Medical System). Fifteen (29.4%) out of 51 patients with thick lesions showed HER-2 overexpression. In contrast, no overexpression was seen in any of the thin lesions. Overexpression of HER-2 in this group of patients was of no prognostic significance for freedom from recurrence or survival when studied using univariate and multivariate analyses. Whilst the incidence of HER-2 overexpression in patients with thick cutaneous primary melanoma is similar to that reported in breast cancer, it was of no prognostic significance for survival in this study. However, further evaluation in larger numbers of patients with the full spectrum of Breslow thickness is clearly indicated.

Prognostic factors of cutaneous melanoma and a new staging system proposed by the American Joint Committee on Cancer (AJCC): validation in a cohort of 1284 patients

This study, involving a cohort of 1284 evaluable patients, validates the American Joint Committee on Cancer (AJCC) proposal for the introduction of ulceration of primary cutaneous melanoma as an independent prognostic factor of survival. In univariate analyses, ulceration (Hazard Ratio (HR) 1.983; P<0.0001; 95% Confidence Intervals (CI) 1.692-2.325) was a predictor of worse overall survival. In multivariate analyses, ulceration (HR 1.302; P=0.022; (95% CI: 1.039-1.633) retained its prognostic significance for survival independent of tumour thickness (HR 1.101; P<0.0001; 95% CI: 1.055-1.150); mitotic activity (HR 1.039; P=0.005; 95% CI: 1.012-1.067); and age (HR 1.009; P=0.006; 95% CI: 1.003-1.016). Ulceration lost its significance in a subgroup analysis of 256 patients with clinically apparent regional lymph node metastases to the number of lymph nodes involved (HR 1.15; P=0.004; 95% CI:1.047-1.263). Ulceration is prognostically significant in the tumour but not the nodal classification of melanoma, with mitotic activity the second most important prognostic factor after tumour thickness.

Serum S100beta protein as a marker of disease activity in patients with malignant melanoma

The purpose of the study was to evaluate serum S100beta protein as a marker of disease activity in patients with malignant melanoma (MM) and compare it with serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH). One hundred sixty-four patients with MM, stages I-IV according to the American Joint Committee on Cancer (AJCC), were studied. Recurrent disease was categorized as active (AD) if metastases were evident clinically or with imaging investigations and inactive (ID) if no metastases were apparent at the time of sample collection. The sensitivity and specificity of S100beta, LDH, and ALP for discrimination between AD and ID were calculated using receiver-operating characteristic curve (ROC) analysis. Serum S100beta, LDH, and ALP concentrations were significantly higher in AD compared to ID. Serum S100beta protein was the best discriminator between AD and ID, the areas under the ROC curve being 0.89, 0.71, and 0.70 for S100beta, LDH, and ALP, respectively. Serum S100beta and LDH levels (both p < 0.0001) and serum ALP levels (p = 0.0014) corresponded with the number of metastatic sites involved. Using a cutoff point of 0.20 microg/L for serum S100beta protein, a specificity of 93% with a sensitivity of 68% was obtained for AD in MM. In stage IV disease, S100 was an independent predictor of survival in univariate (p = 0.001; hazard ratio = 1.0156) and multivariate (p = 0.038; hazard ratio = 1.0108) analyses. Serum S100beta protein is a better indicator of disease activity in MM than LDH or ALP and is an independent predictor of survival in stage IV disease.

Adjuvant therapy of malignant melanoma: is there a choice?

The methodological differences, data interpretation and conclusions of recent studies of adjuvant therapy in high-risk malignant melanoma, are discussed in detail in this communication. Two observations emerge from this analysis:There is as yet no adjuvant treatment that has conclusively been shown to influence overall survival for high-grade primary lesions with or without clinically occult microscopic metastases in regional lymph nodes. With currently available drugs, meaningful benefit is more likely, if adjuvant treatment is administered on development of clinically apparent regional lymph nodes metastases. The paradox of adjuvant therapy being apparently more effective in more advanced stages of the disease is not unique to melanoma and has been observed in other cancers. This paradox can be explained by the notion that currently available treatments will not eradicate the last malignant phenotype. They may, however, anticipate and frustrate the clinical expression of the next episode of disease activity, in a defined period of time.

What is the optimal therapy of brain metastases?

The conclusions of a symposium held in London in October 1999 and devoted to the optimal management of brain metastatic disease were: 1. Prognostic factors are: size and number of metastases (and the presence of mass effect); the status of the systemic cancer outside the central nervous system; performance/neurological status; the age of the patient; and the type of cancer. 2. Surgical management of the single, superficially located brain metastasis with symptomatic mass effect is recommended in good performance status patients. Many would follow this routinely by whole brain radiotherapy. 3. Whole brain radiotherapy is often not followed by durable control of the disease and carries morbidity; better management plans are required. In poor prognosis patients the delivery of radiotherapy may not always be indicated. 4. The current literature demonstrates that stereotactic radiosurgery can enhance the likelihood of sterilizing individual brain metastases compared with whole brain radiotherapy alone. 5. The results of questionnaire showed that the histological diagnosis and latency to onset made little difference to the opinion of neuroscience clinicians, who generally favoured stereotactic radiation therapy over whole brain radiotherapy (with or without a conventionally delivered boost) for all patients with less than four metastases. The opinions of oncologists differed. For bronchial and breast cancer patients, whole brain radiotherapy, with or without a boost, was favoured by the majority, particularly in oat cell cancer. However, with a long latency to 'isolated' brain metastasis, oncologists favoured focal radiation therapy. There was a strong preference amongst oncology experts to reserve stereotactic radiation therapy for apparently isolated brain metastasis; this opinion applied to bronchus and breast cancer, and also to melanoma. 6. Whole brain radiotherapy followed by positron emission tomography scanning to determine what viable metastatic disease remained (and potentially treatable by stereotactic/focal technology) was favoured by most of delegates who answered this question.

Melanoma involving the gastrointestinal tract

We studied 19 patients, 12 males and 7 females of a median age of 49 years (range 26-76) with clinical manifestations of gastro-intestinal (GI) involvement from malignant melanoma. Their records were available from an electronic database of 2163 patients registered between 1977 and 1998 with the Melanoma Unit initially at Westminster and currently at Charing Cross Hospital. Time interval from initial presentation of melanoma to the development of GI involvement ranged from 6 to 183 months (median 44 months). Twelve patients had a laparotomy and in eight of these resection of metastatic sites was complete. Ten patients received systemic treatment. Median survival from GI involvement for patients who had resection of metastases was 21.5 months (range 1 to 253 months). Enterectomy, especially in the presence of solitary intestinal metastases, can palliate and may prolong survival. The role of adjuvant chemotherapy is less well defined but is worthy of consideration.

In vitro cytotoxicity of norviburtinal and isopinnatal from Kigelia pinnata against cancer cell lines

Crude dichloromethane extracts of Kigelia pinnata stem bark and fruit showed cytotoxic activity in vitro against cultured melanoma and other cancer cell lines using the Sulphorhodamine B assay, which was used for bioassay-guided fractionation. Thin layer chromatography (TLC) examination of the most active fractions of both stem bark and fruits showed the presence of the same major components which were found to be norviburtinal and beta-sitosterol. Norviburtinal was found to be the most active compound but had little selectivity for melanoma cell lines whilst isopinnatal also showed some cytotoxic activity. beta-Sitosterol was found to be comparatively inactive. HPLC analysis of the crude extract showed that the amount of norviburtinal present in the plant material did not account for all of the activity of the total extracts.

Oxaliplatin is active in vitro against human melanoma cell lines: comparison with cisplatin and carboplatin

We have previously confirmed the in vitro activity of cisplatin and carboplatin against human melanoma cell lines. Both drugs are important components in the chemotherapy used in our service for advanced metastatic melanoma. In this communication we report the in vitro activity of oxaliplatin against human melanoma cell lines in comparison with cisplatin and carboplatin. Oxaliplatin was found to be active against C32 and G361 cell lines with IC50 values of 49.48 and 9.07 microM (1 h exposure), 9.47 and 1.30 microM (4 h exposure), and 0.98 and 0.14 microM (24 h exposure), respectively. The cytotoxic activity of oxaliplatin in this in vitro system appears to be significantly superior to that of carboplatin. Its activity becomes comparatively closer to that of cisplatin as exposure time increases. Indeed at a 24 h exposure oxaliplatin appears to be significantly more active than cisplatin against the G361 cell line (p=0.0343). Oxaliplatin merits evaluation in the clinic both as a single agent and in combination with other drugs active against melanoma.

Melanoma and additional primary cancers

The aim of this study was to examine the occurrence of additional, unrelated primary cancers in patients with melanoma. Data from the hospital-based, melanoma registry of a specialist unit (the Melanoma Unit at Charing Cross Hospital, London, UK) were compared with the incidence rates in a population-based cancer registry (the Thames Cancer Registry). In total, 2076 patients with the histological diagnosis of melanoma established between 1960 and 1997 who were registered with the Melanoma Unit at Charing Cross Hospital, were included in the study. Patterns in time and in the tumour type of the additional cancers were analysed in the cohort. The relative risk of subsequent cancers was evaluated, the number of expected cancers being calculated by applying incidence rates in the population of south-east England to the person-years of follow-up in the cohort. Sixty-six (3%) of the 2076 evaluable patients had a history of, or developed, 69 histologically verified additional cancers, the commonest being colorectal, breast and lymphoma. Twenty-six additional cancers preceded the diagnosis of melanoma by 1-42 years, 16 were diagnosed within 12 months and 27 followed the diagnosis of melanoma, 1-28 years later. Seven cancers occurred after chemotherapy for metastatic melanoma: two colorectal, one bladder, one renal, two myelodysplasias and one acute myeloid leukaemia. The relative risk of additional cancers developing after the diagnosis of melanoma during the 8537 evaluable years-at-risk was 0.64 (95% confidence interval 0.41-0.96; P = 0.0006). Thus, the risk of additional cancers following treatment for metastatic melanoma in this cohort is small. The potential influence of other factors on the occurrence of additional cancers observed overall in this study requires further investigation.

Detection of tyrosinase mRNA by RT-PCR in the peripheral blood of patients with advanced metastatic melanoma

Detection of melanoma cells in the peripheral blood has been facilitated by the reverse transcriptase-polymerase chain reaction (RT-PCR), but their presence is of uncertain importance in the evolution of the disease. We studied the detection of melanoma cells using RT-PCR in the peripheral blood of 21 patients, four with regional lymph node metastases (American Joint Committee on Cancer [AJCC] stage III) and 17 with disseminated disease (AJCC stage IV). RNA was extracted from 10 ml of heparinized blood following density gradient centrifugation and converted into cDNA for PCR analysis. Assay sensitivity of 10 cells in 10(7) mononuclear cells and granulocytes obtained from 10 ml of peripheral blood was achieved using the G361 and C32 melanoma cell lines. Tyrosinase mRNA was not detected in control samples from healthy volunteers or patients with non-malignant disease. Six patients (one stage III, five stage IV) tested positive for tyrosinase mRNA (28.6%); with one exception, all patients were receiving chemotherapy at the time of sampling. Of the six positive results, three were from patients who initially tested negative but were subsequently positive after a 3-4 week interval. The low detection rates of melanoma cells in the peripheral blood of patients with widely disseminated disease is consistent with recent reports and correlates poorly with the clinical stage of melanoma. This may be partly explained by the clinically observed intermittent and random evolution of melanoma metastases.

In vitro synergy of paclitaxel (Taxol) and vinorelbine (navelbine) against human melanoma cell lines

Paclitaxel (PTXL) (Taxol), a taxane, and vinorelbine (VRB), a semisynthetic vinca alkaloid drug, have tubulin as their common intracellular target, but inhibit growth by binding to different sites. We evaluated in vitro the antiproliferative activity of these two drugs as single agents and in combination, against two human melanoma cell lines, G361 and StM111a. The SRB (sulphorhodamine B) assay was used to determine growth inhibition. Possible drug-drug interaction at the cellular level was assessed by constructing Isoboles (Isobologram analysis) and applying the concept of an 'envelope of additivity'. Both agents were active in the nanomolar range at clinically achievable concentrations. The mean IC50 for G361 was 46.6 nM (PTXL) and 19.9 nM (VRB) after a 1 h drug exposure. Mean IC50 (1 h) for StM111a was 9.7 nM (PTXL) and 26.9 nM (VRB). Isobole analysis at the isoeffect levels of 25%, 50% and 75% indicated that drug interaction was predominantly synergistic (supra-additive) when paclitaxel and VRB were added concurrently for 1 h to cultures of StM11 1a or G361. In some experiments, this synergy was observed with particularly low concentrations of paclitaxel (3 nM) and VRB (0.01 nM). A new points were located within the envelope of additivity or in the subadditive (antagonism) region of the isobole. An overall synergy was also found if the data were analysed by the median effect analysis. The effect of these agents on the cytoskeleton and ultrastructure were studied with immunofluorescence and electron microscopy, respectively. These results confirm the in vitro inhibitory activity of paclitaxel and VRB against malignant melanoma, but more importantly the two drugs appear to act synergistically at relatively low concentrations.

Systemic treatment of malignant melanoma: grade is as important as stage

The prognosis of malignant melanoma relates to the biological profile of the tumour and is independent of the magnitude of surgery on the offending primary lesion. The optimal management of this cancer throughout its evolution depends on the appraisal of its metastatic potential. With better understanding of the natural history of the disease and improvements in the therapeutic ratio of currently available drugs, systemic treatment of high risk melanoma in the adjuvant context and before dissemination is emerging as a therapeutic priority. There is now evidence from recently published, controlled studies with long follow up that this approach can prolong relapse-free and overall survival.

The combination of paclitaxel with cisplatin exhibits antagonism in vitro against human melanoma

The in vitro cytotoxicity of paclitaxel and cisplatin, alone and in combination, was evaluated against the established human melanoma cell line, G361, with either 1 or 24 h asynchronous paclitaxel exposure using the sulforhodamine B assay. As single agent, the mean cisplatin concentration which inhibited G361 cell growth by 50% (IC50) was 10,000 nM for 1 h exposure. IC50 values obtained with 1 and 24 h paclitaxel exposure were, respectively, 63 and 3.8 nM, concentrations clinically achievable. The combination of paclitaxel with cisplatin was found to be antagonistic by the classical isobologram method, independent of drug sequence and of paclitaxel exposure time. The antagonism was significantly more pronounced for the sequence of paclitaxel followed by cisplatin compared with the reverse sequence for both 1 and 24 h paclitaxel exposure time (p < 0.05). Future clinical protocols employing paclitaxel and cisplatin, both active single agents for the treatment of metastatic malignant melanoma, should take into consideration that the combination of the two drugs may result in significant antagonism, irrespective of drug sequence, if administered within a short interval of each other.

Taxol and vinorelbine: a new active combination for disseminated malignant melanoma

We evaluated the activity and toxicity of two sequences of taxol combined with vinorelbine in disseminated malignant melanoma, metastatic beyond regional lymph nodes. Fifteen previously untreated patients, nine males and six females (median age 56 years), were enlisted between May 1994 and February 1995. Eight patients received vinorelbine 30 mg/m2 (maximum dose 50 mg) first, follow 24 h later by taxol 120 mg/m2 (maximum dose 240 mg) infused over 3 h (the V/T sequence). Seven patients received the reverse (T/V) sequence. In 79 administered courses there were no anaphylactic episodes, the main toxicity being alopecia (WHO grade 3). Significant neutropenia, emesis or neuropathy was not observed in either schedule (WHO grades 0 or 1). Three major responses, all with the V/T sequences, were seen; one complete (CR) in nodal and cutaneous sites lasting 13 months and two partial (PR), omental, ascites in one and hepatic, splenic and nodal in the other, lasting 7 and 6 months, respectively. Clinically meaningful tumor regressions, not qualifying strictly for the criteria of major response, were observed in two additional patients in the T/V sequence. Taxol combined with vinorelbine is active against disseminated malignant melanoma. The importance of sequencing the two drugs remains to be determined with accrual of more patients into the study.

Activity of platinum drugs against melanoma cell lines: is it modulated in vitro in the presence of tamoxifen?

Cisplatin and carboplatin have been used against human malignant melanoma as single agents and in combination. Tamoxifen is used in the treatment of breast cancer, but has no significant activity against human malignant melanoma. Tamoxifen, however, has been promoted as a modulator in some drug regimens. The addition of tamoxifen to cisplatin or carboplatin has been reported to enhance their activity against the human melanoma cell line T-289. We investigated whether tamoxifen potentiates, in vitro, the activity of cisplatin and carboplatin against C32, G361 and StMl11a melanoma cell lines. Tamoxifen alone at clinically achievable concentrations of 0.1 and 1.0 microM (168 hrs exposure) had no significant effect on growth. No chemopotentiation of the activity of cisplatin or carboplatin was observed with the addition of tamoxifen (0.1 and 1.0 microM). The platinum drugs were added for 1 hr (serially diluted from 100.0 microM). Against the G361 line there was a trend towards chemopotentiation of cisplatin by 0.1 microM of tamoxifen. However, this did not reach statistical significance. Tamoxifen (5.0 and 10.0 microM) produced some inhibitory activity, and a trend towards synergy with cisplatin was observed. However, these concentrations are not clinically feasible. Previous reports detecting synergistic interaction between tamoxifen (0.1 and 1.0 microM), and the platinum compounds against the T-289 melanoma cell line cannot be supported in our in vitro system.

Cutaneous melanoma-associated retinopathy

PURPOSE

To define further the syndrome of cutaneous melanoma-associated retinopathy, of which only five affected patients have been reported previously.

METHODS

Three men with melanoma-associated retinopathy were examined and studied electrophysiologically. Two were studied in detail psychophysically.

RESULTS

Visual symptoms consisted of flickering black and white spots, shimmering patches of colors, and night blindness. The onset was acute and nonprogressive. Reduced amplitudes were observed in the flash electroretinographic b-wave and the pattern electroretinogram. Color vision, contrast sensitivity, and light- and dark-adapted perimetric sensitivities were abnormal. In one patient, the rate of dark adaptation was normal with elevated final cone and rod thresholds.

CONCLUSIONS

Melanoma-associated retinopathy is a paraneoplastic syndrome distinct from cancer-associated retinopathy with a different visual prognosis. It may preferentially affect men.

Activity of extracts of Kigelia pinnata against melanoma and renal carcinoma cell lines

Serial dilutions of standardised water, ethanol, and dichloromethane extracts of the stembark and fruits of Kigelia pinnata were tested for their growth inhibitory effects against four melanoma cell lines and a renal cell carcinoma line (Caki-2) using two different (MTT and SRB) assays. Lapachol, a possible constituent of these extracts, together with known therapeutic antineoplastic agents, was also tested in the same way. The IC50 of each extract was measured after extracts were diluted to 100 micrograms/ml in 1% ethanol or water. Significant inhibitory activity was shown by the dichloromethane extract of the stembark and lapachol (continuous exposure). Moreover, activity was dose-dependent, the extract being less active after 1 h exposure. Chemosensitivity of the melanoma cell lines to the stembark was greater than that seen for the renal adenocarcinoma line. In marked contrast, sensitivity to lapachol was similar amongst the five cell lines. Lapachol was not detected in the stembark extract.

Clinical and histologic involvement of regional lymph nodes in malignant melanoma. Adjuvant vindesine improves survival

BACKGROUND

This report is a study of prognostic factors, including adjuvant chemotherapy, that influence survival of patients with malignant melanoma who have clinical and pathologic involvement of regional lymph nodes.

METHODS

A total of 169 evaluable patients with malignant melanoma metastatic to regional lymph nodes were registered consecutively and prospectively between June 1977 and December 1986 in the computerized data base of the melanoma registry at Westminster Hospital. Eighty-seven of these patients received adjuvant chemotherapy with vindesine after resection of palpable metastatic lymph nodes, and 82 had no systemic treatment after surgery. All were followed up for at least 2 years (median, 8 years) after involvement of regional lymph nodes was noted or until death. Statistical analyses included simple life-table comparisons, unadjusted for covariates. In addition, Breslow's thickness, ulceration of the primary lesion, its anatomical location, number of regional lymph nodes histologically involved, dissection site, patient age and sex, and adjuvant vindesine therapy were included as covariates in Cox regression models.

RESULTS

The disease-free interval (P = 0.0001), time to dissemination from lymph node metastases (P < 0.0001), survival time after lymph node dissection (P = 0.0227) and overall survival time after initial diagnosis of malignant melanoma (P = 0.0095, log-rank chi-square test) were superior for the 87 patients who received adjuvant chemotherapy with vindesine. Cox regression analysis confirmed adjuvant vindesine as a highly significant variable influencing all of these outcomes, including overall survival time after first diagnosis (P = 0.003).

CONCLUSIONS

The apparent effect of adjuvant vindesine on overall survival in this study is large (hazard ratio, 0.52) and highly statistically significant. Adjuvant vindesine therapy merits consideration for malignant melanoma metastatic to regional lymph nodes. However, these results observed in concurrent, but nonrandomized, patients clearly require confirmation.

Growth inhibitory activity of S12363, a novel vinca alkaloid derivative on human melanoma cell lines

The growth inhibitory activity of S12363, a new antineoplastic agent which belongs to the vinca alkaloid group incorporating an amino-phosphonate (bioester of valine), was studied on six human melanoma cell lines with different phenotypic characteristics and in vitro growth rates. S12363 was compared with vinblastine (VBL), vincristine (VCR) and vindesine (VDS) using the MTT assay. Inhibition was time- and dose-dependent. Overall, IC50 values ranged from 24-6770nM and 4.6-11.6 nM for the reference drugs and for S12363 respectively, after exposure for 1 hr. All the vinca alkaloids were more active when cells were exposed continuously for 72 hrs, inhibition by S12363 was greater than the reference drugs (p < 0.05 in 15/18 comparisons). The activities of VDS and S12363 were also compared using the clonogenic assay. IC50 values ranged from 45-500 nM and 17-75 nM respectively. On a molar basis, S12363 was significantly more active than VDS (ANOVA p < 0.0001). The shape of the cell survival curve obtained with S12363 was exponential, whereas that of VDS was of the exponential-plateau type. Furthermore, survival with higher concentrations of S12363 was inversely related to cells seeded. Cell cycle analysis showed these compounds to block cells in G2+M after exposure to their respective IC50 concentrations for 1 hr. This effect was obtained using a lower S12363 concentration. In summary, S12363 proved to be 18-83 times more active than the reference drugs in the MTT and 3-11 times more active than VDS in the clonogenic assay. Its high potency and dissimilar cell survival profile indicate that this compound possesses different biological properties, and therefore merits further in vivo evaluation.

Evaluation of S12363, a novel vinca alkaloid drug in the treatment of advanced malignant melanoma. A phase II study

We conducted a phase II study with the new vinca alkaloid derivative S12363 in ten patients with metastatic malignant melanoma. Six patients had been pre-treated with other cytotoxic agents and all had received Vindesine. Four patients had no prior systemic treatment before entry into the study. S12363 was well tolerated subjectively, the main toxicity being haematological. Despite encouraging in vitro observations, no objective responses to S12363 have been documented in these patients with the doses and schedule used in this study. S12363 appears to have no clinically useful activity in metastatic malignant melanoma.

Metastasis to the penis from malignant melanoma: case report and review of the literature

A case of metastatic malignant melanoma to the shaft of the penis is described and the literature reviewed to collate the incidence of primary sites which metastasize to the penis. Less than 260 cases of metastasis to the penis have been reported. Of these, 76% are from genitourinary primary sites and 17% are from gastrointestinal primary sites but only one case of metastatic melanoma to the penis has been previously reported. The described case presented with painful priapism while receiving combination chemotherapy for metastatic disease. A CT scan demonstrated a deposit in the left corpora cavernosa and needle aspiration cytology of a plaque attached to the shaft confirmed malignant melanoma cells. Palliation of the painful priapism was achieved by treatment with radiotherapy using large doses per fraction. Retrograde venous or lymphatic spread may have been the cause of a metastasis at this site. Prognosis is very poor.

Antiproliferative activity of vinorelbine (Navelbine) against six human melanoma cell lines

We compared in vitro the cytotoxic activity of vinorelbine (VRB) (Navelbine, 5'-nor-anhydro-vinblastine) a novel Vinca alkaloid, with that of vinblastine (VBL) vincristine (VCR) and vindesine (VDS). Five continuous human melanoma cell lines (C32, G361, StMl11a, StMl12d and StMl14a) and a new line WHMel 1, were used in this study. In growth-inhibition assays, VDS and VRB exhibited comparable cytotoxicity against the C32 and G361 melanoma lines; the effect being dose- and time-dependent. VRB appeared less inhibitory compared to VDS in the lowest concentrations (0.1-1 nM). The same activity was observed with 0.1-1 microM. These drugs exhibited comparable growth inhibition at clinically achievable doses. The MTT assay was used to compare VBL, VCR, VDS, and VRB. Overall IC50 values (concentration required to reduce viability by 50%) ranged from 1 pM to 10 nM. The reduction in cell viability with VRB was similar to that observed with the reference drugs in four out of five lines tested by this method. However a trend was observed for IC50 values to be lower with VBL and VDS. In clonogenic assays (StMl11a, StMl12d and StMl14a lines, 1 h exposure) VRB and VDS produced the same reduction in survival. Survival curves were exponential followed by a terminal plateau. IC50 values ranged from 60 nM to 70 nM. Our results indicate that VRB has in vitro activity against six melanoma lines with differing phenotypic characteristics.

Alpha-interferons: impact on survival of patients with renal cell carcinoma

We studied the effect of treatment on tumour response and survival of 76 evaluable patients with renal cell carcinoma, treated in this unit over a 12-year period. For the purpose of this study patients were classified into three groups according to the treatment they received: (a) 22-patients were evaluable for treatment with alpha-interferons; (b) 20 for treatment with immune modulation, other than interferon; (c) 34 patients received hormone treatment, chemotherapy or had no systemic treatment. Objective tumour regressions were observed only among patients who received interferon. No difference in overall survival from first diagnosis or from diagnosis of Stage IV disease could be demonstrated in these three groups. Alpha-Interferons are the first agents to induce clinically meaningful and reproducible regression of metastases in renal cell carcinoma. This treatment, however, has not been shown to have a major impact on survival.

Effect of the position of the cyano-group of cyanopregnenolones on their drug metabolic inducing activity

The effect of the position of the cyano-group of several cyanopregnenolones on the body's resistance to drugs and on drug metabolism was investigated. Female rats were pretreated with 2 alpha-, 6-, 16 alpha-, 17 alpha-cyano- or 16 alpha-cyanomethyl-pregnenolone or with pregnenolone, and the (in vivo) resistance to zoxazolamine, digitoxin and indomethacin, as well as the in vitro drug metabolism (post mitochondrial fraction) of zoxazolamine and ethylmorphine were determined. It was found that the 16-derivative was the most active in this respect, the 2- and 17-cyanopregnenolones were less active but significantly potent compared to controls, while the 6-cyano, the 16-cyanomethyl derivatives and pregnenolone were essentially inactive. These differences were explained in terms of an effective or poor fit of the steroids to their receptor. The poor performance of pregnenolone-16 alpha-acetonitrile was attributed to electronic effects. A hypothesis of some structural features of the receptor site for its interaction with the cyanopregnenolone inducers was presented.

Synthesis of 2-, 4- and 5-benzoylpyrrole-3-acetic acids and study of their in vitro effects on active oxygen species

The isomeric benzoylpyrrole-3-acetic acids 2a-4a were synthesized on the basis of the known biological interest of analogous pyrrole-1- and pyrrole-2-acetic acids. The electrophilic benzoylation of ethyl pyrrole-2-acetate was found to give mixtures of the three substituted on the carbon atoms of the pyrrole ring isomers 2-4 in ratios which varied with the employed conditions. Experimental procedures were developed for the preferential formation of each one of the isomers in synthetically useful amounts. The involvement of the synthesized compounds in active oxygen intermediates was tested in vitro by examining their effect on lipid peroxidation using heat inactivated rat hepatic microsomes, and as hydroxyl radical scavengers, by determining the inhibition of formaldehyde production from the oxidation of DMSO. For comparison, some ESR spectra were recorded. It was found that 3 moderately inhibited lipid peroxidation, while all derivatives tested were potent hydroxyl radical scavengers. It is proposed that the reported compounds could find useful applications as protective agents against oxygen toxicity.

Lipophilicity of some substituted morpholine derivatives synthesized as potential antinociceptive agents

Some substituted 2-alkoxy-morpholines have been synthesized as potential antinociceptive agents. These compounds share some structural characteristics of the piperidine analgesics. Their lipophilicity, expressed as log P (octanol-water) and as RM values (from reversed phase thin layer chromatography) was determined. Correlation of these two lipophilicity parameters indicated the classification of the tested compounds into two subgroups. Acute toxicity and, for some selected structures, analgesic activity are reported.