Chemohormone therapy of metastatic melanoma with megestrol acetate plus dacarbazine, carmustine, and cisplatin

Abstract

Background. Chemotherapy with dacarbazine, carmustine, and cisplatin produces a modest objective response rate in melanoma. Megestrol acetate may ameliorate cachexia, abrogate drug resistance, and increase survival time in melanoma. Methods. Nineteen patients with metastatic melanoma (16 evaluable) treated with dacarbazine (220 mg/ m2/day for 3 days, intravenously [IV]), cisplatin (25 mg/ m2/day for 3 days IV) every 3 weeks, and carmustine (150 mg/m2 IV single dose every 6 weeks) together with megestrol acetate (160 mg/day by mouth continuously) starting 2 days before chemotherapy. Results. This regimen was well tolerated and resulted in a mean net weight gain of 1.45 kg. A 47% objective response rate was observed in all patients, including visceral sites of response, with a 39+ week median duration of response and median survival time of 16.7+ months in all evaluable patients. Conclusions. In this small Phase II study, the authors showed that megestrol acetate may contribute to a high objective response rate and prolonged median survival when used with a chemotherapy regimen of dacarbazine, carmustine, and cisplatin.

Systemic therapy of disseminated malignant melanoma: an evidence‐based overview of the state‐of‐the‐art in daily routine

“…Trials conducted by the European Organization for Research and Treatment of Cancer (EORTC) 80 could not determine any antitumoral activity of a single agent strategy with tamoxifen 81,82 . Similarly insufficient are hormonal therapies with cyproterone acetate and gestagens like megestrol acetate or medroxyprogesterone 83,84 …”

“…Trials conducted by the European Organization for Research and Treatment of Cancer (EORTC) 80 could not determine any antitumoral activity of a single agent 81,82 Similarly insufficient are hormonal therapies with cyproterone acetate and gestagens like megestrol acetate or medroxyprogesterone. 83,84 Tamoxifen is regarded as a synergistic agent to chemotherapy according to calcium channel blocking capacity and as modulator of multidrug-resistance. 67,[85][86][87][88][89][90] However, in the last decade, large randomized trials with tamoxifen in combination with either dacarbazine alone or in combination with IFN-α , as adjunct to DTIC + DDP or the Dartmouth regimen failed to show an advantage for the addition of tamoxifen.…”