Malignant melanoma brain metastases. Review of Roswell Park Memorial Institute experience.

One-hundred twenty five of 700 patients with malignant melanoma treated at Roswell Park Memorial Institute from 1972 to 1978 were found to have brain metastases. Seventy-three percent of the patients had multiple brain metastases. Male to female ratio was 1.9:1. The median survival of the untreated group of patients was 3 weeks as compared with that of 6 weeks for the patients maintained on steroids only, 9 weeks for those who received radiotherapy, 11 weeks for the patients treated with intraarterial chemotherapy, and 26 weeks for the patients who underwent successful surgical excision of a solitary lesion.

Cyclic alternating combination chemotherapy for small cell lung cancer.

Sixty-two patients with small cell carcinoma of lung received cyclic alternating non-cross-resistant combination chemotherapy. Radiation to the chest was given to all the patients. Patients were given a course of VP16, adriamycin and vincristine (VAV) followed by radiation (3,000 rads) to the chest and then a second course of VAV. Three weeks later, a course of cytoxan, CCNU, and methotrexate (CCM) was given (6 weeks). Subsequently, the treatment was cycled between two courses of VAV (6 weeks) and one course of CCM (6 weeks). Overall objective response rate of 73%, with 45% complete response, was noted. Overall median survival was 50 weeks, with 83 weeks for complete responders. Median survival for patients with regional disease was 58 weeks compared to 40 weeks for extensive disease. All the patients headed for complete response did so prior to receiving CCM. These results were not superior to conventional combination chemotherapy regimens.

Phase II study--intra-arterial BCNU therapy for metastatic brain tumors.

Thirty-one patients with metastatic brain tumors (MBT) from lung cancer and ten patients with MBT from melanoma received BCNU, 100 mg/m2, every four weeks by intracarotid and/or vertebral artery infusion into each involved site. Twenty-five patients with lung cancer and all melanoma patients are currently evaluable. Twelve patients with lung cancer had complete and partial responses lasting from 1 to 14 months. Four of them with the histologic diagnosis of small cell carcinoma, one with large cell carcinoma and one with squamous cell carcinoma showed complete response. None of the patients with melanoma MBT experienced any response. All of the patients had periorbital erythralgia and/or occipital pain during the infusion. Four patients manifested mild focal seizures during the infusion or 6 to 24 hours after the treatment. Transient confusion with disorientation was observed in two patients 4 and 24 hours, respectively, after a BCNU infusion. Two patients developed reversible thrombocytopenia after the fifth course of the IA chemotherapy. Median survival of patients with MBT from lung carcinoma was 4 months, with two of them still alive at 10 and 14 months, respectively. Only one patients of the 25 with lung carcinoma died from MBT. Failure to control the primary disease resulted in the deaths of a vast majority of the patients.

Progress in the chemotherapy of small cell carcinoma of the lung.

A comparison was made between six different approaches to the chemotherapy of small cell carcinoma of the lung. The value of single-agent chemotherapy was compared to combination chemotherapy and radiation therapy, and with cyclic alternating combination chemotherapy in 161 patients. Cyclic alternating chemotherapy with modest radiation therapy to the primary site provided significant advantages over single-agent or combination chemotherapy. A combination of VP-16 + Adriamycin + vincristine seemed particularly effective in inducing an initial objective tumor response rate of 83%, with a projected median survival of 13.2 months. Of patients treated with cyclic alternating therapy, 51% were alive at one year. It thus appears that where complete response is achieved, prolonged disease-free survival can be expected.

Doxorubicin, cisplatin, and Corynebacterium parvum in non-small cell bronchogenic carcinoma.

Forty previously untreated patients with stage III non-small cell bronchogenic carcinoma were treated with doxorubicin (Adriamycin) at a dose of 60 mg/m2 iv on Day 1 and cisplatin (cis-diamminedichloroplatinum[II]) at a dose of 60-80 mg/m2 iv on Day 1, every 4 weeks. Each patient was randomized to receive iv Corynebacterium parvum either on Day 1 or on Day 14 of each 4-week cycle. There were no complete responses and only seven of 40 (17.5%) patients achieved a partial response, with an overall median survival of 23 weeks. Those patients with stable disease survived longest. There was no difference in median survival among those patients receiving C. parvum on Day 1 (25 weeks) and among those receiving C. parvum on Day 14 (17 weeks).