Combination chemotherapy in malignant melanoma

Twenty-six patients with disseminated malignant melanoma were treated with a combination of 1:3 bis (2-chloroethyl)-l-nitrosourea (BCNU) and vincristine sulfate (VCR) repeated at 28-day intervals. Of 20 evaluable patients, 9 had 50% or more regression in measurable tumors. Three patients achieved a state of no measurable disease, but 2 relapsed 113 and 131 days, respectively, after treatment was discontinued. One patient remains free of disease at 686 days. Responses were seen in pulmonary, lymph node, cutaneous, and subcutaneous metastases. There was little effect on hepatic metastases and none on bone metastases. Responses of central nervous system disease were impossible to evaluate because of concomitant use of x-ray and steroids. Drug toxicity was significant but acceptable, and most patients received treatment as outpatients. The response rate of 43% in an apparently homogeneous group of patients would seem to warrant prosecution of further studies utilizing combinations of active drugs in disseminated melanoma.