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Fotemustine--an advance in the treatment of metastatic malignant melanoma
O Merimsky1, M Inbar, B Gerard
1Department of Oncology, Ichilov Hospital, Tel-Aviv, Israel.
Abstract:
Although chemotherapy has been generally of limited clinical benefit in the treatment of metastatic malignant melanoma (MMM), fotemustine (FM) is a newly developed drug which is active against this disease. Twenty-four patients with histologically proven MMM were treated with fotemustine, with or without dacarbazine (DITC) according to different phase II trials. In the first schedule, three patients received FM alone on days 1, 8, 15 followed by a 5-week rest period. The second schedule consisted of FM administered on days 1 and 8 alternating with DTIC on days 15 and 16, followed by a 5-week rest period (19 patients). The third schedule, given to two patients, consisted of DTIC followed 4 h later by FM. The overall response rate was 8.3%. Response in those who were treated with alternating drugs, included one partial response (PR) in the brain which lasted 4 months, and one PR in brain metastases with complete response (CR) in lymph nodes for 4 months. Clinical and radiological evidence of regression was observed mainly in brain metastases (22.2%), reflecting the intracerebral activity of the drug. It seems that fotemustine is superior to any other drug currently available in the treatment of these metastases.
Insights
Fotemustine (FM) shows activity against metastatic malignant melanoma (MMM), particularly in brain metastases. This new chemotherapy agent demonstrates potential superiority over existing treatments for this challenging condition.
Area of Science:
- Oncology
- Pharmacology
Background:
- Metastatic malignant melanoma (MMM) has limited response to traditional chemotherapy.
- Fotemustine (FM) is an emerging chemotherapeutic agent investigated for MMM treatment.
Purpose of the Study:
- To evaluate the efficacy and activity of fotemustine (FM), alone or in combination with dacarbazine (DTIC), in patients with metastatic malignant melanoma (MMM).
Main Methods:
- Phase II clinical trials involving 24 patients with histologically confirmed MMM.
- Three treatment schedules were employed: FM alone, alternating FM and DTIC, and sequential DTIC followed by FM.
- Response rates and regression evidence, particularly in brain metastases, were assessed.
Main Results:
- An overall response rate of 8.3% was observed.
- Partial responses (PR) in brain metastases and complete response (CR) in lymph nodes were noted in patients receiving alternating FM and DTIC.
- Significant regression was observed in brain metastases (22.2%), indicating fotemustine's intracerebral activity.
Conclusions:
- Fotemustine (FM) exhibits activity against metastatic malignant melanoma (MMM), with notable efficacy in treating brain metastases.
- FM may offer a superior treatment option compared to current therapies for melanoma brain metastases.