Single-agent temozolomide may be an effective option for late adjuvant therapy in patients with melanoma

Late adjuvant therapy is the term to define the treatment administered following complete resection of metastatic or relapsed disease.

To assess the efficacy of single-agent temozolomide, a standard agent is used for metastatic melanoma in late adjuvant chemotherapy for cutaneous melanoma.

Twenty-seven adult cutaneous melanoma patients whose relapses were completely resected were included in this study. Temozolomide was administered as follows: peroral, 200 mg/m² once daily for five consecutive days of a 28-day treatment cycle for six cycles.

The median age was 55 years and men were predominant (74%). Median follow-up time was 23.6 months (range, 3.6-122.6 months). Any type of relapse occurred in 14 (51.9%) patients, and five patients relapsed while on chemotherapy. Almost all relapses (n = 13, 93%) occurred within the first two years of follow-up. The relapse rates were found 37.4 and 49.1% in the first and second years of follow-up, respectively. Moreover, after fifth year of onset of chemotherapy, relapse rate was found only 51.9%. The median relapse-free survival (RFS) was 12.9 months, and 1-, 2-, 3-, and 5-year RFS rates were 60, 46, 39, and 39%, respectively. The estimated median overall survival was 23.6 months. All patients survived first year (n = 27, 100%), and the overall survival rates for 2, 3, and 5 years were 81, 48, and 48%, respectively.

Single-agent temozolomide may be a rational and prudent option for late adjuvant therapy in melanoma patients if/when novel therapies, such as targeting and immune therapies, are not accessible or available.