A prospective evaluation of a triple-drug regimen containing cisplatin, vinblastine, and dacarbazine (CVD) for metastatic melanoma

Abstract

Based on the independent activity of cisplatin, vinblastine, and dimethyl‐triazeno‐imidazole‐carboxamide (DTIC) (CVD), a combination of these agents was used in the treatment of patients with advanced melanoma. Vinblastine was used in a dose of 1.6 mg/m²/d for 5 days, DTIC was used in a dose of 800 mg/m² intravenously (IV) on day 1, and cisplatin was used in a dose of 20 mg/m²/d for 4 days starting on day 2 of chemotherapy. The courses of chemotherapy were repeated at 3‐week intervals. All patients were premedicated with antiemetics, and IV hydration was used before cisplatin. Fifty‐two consecutive patients were registered and 50 were evaluable for response. Two patients achieved a complete response (CR) and 18 patients had a partial response (PR) for an overall response rate of 40% (95% confidence interval, 27% to 55%). The median duration of response was 9 months and the median survival time of the responders was 12 months. The overall median survival time of patients treated on this protocol was 9 months. The treatment was associated with significant toxicity consisting of nausea, vomiting, diarrhea, and partial hair loss. Additionally, neutropenia with a median nadir granulocyte count of 500/μl was observed, and significant anemia required blood transfusions in a majority of the patients after three to four courses of chemotherapy. The dose‐limiting toxicity was peripheral neuropathy which required discontinuation of cisplatin after six to eight courses of chemotherapy. We believe that this triple‐drug regimen has significant activity that appears to be superior to the single‐agent activity of these drugs, both in terms of increased response rate and duration of response.