Complete Remission of Brain Metastases in Three Patients with Stage IV Melanoma Treated with BOLD and G-CSF

• Published in: Japanese journal of clinical oncology 2005-09, Vol.35 (9), p.507-513
• Main Authors: Bottoni, Ugo, Bonaccorsi, Paola, Devirgiliis, Valeria, Panasiti, Vincenzo, Borroni, Riccardo Giovanni, Trasimeni, Guido, Clerico, Rita, Calvieri, Stefano
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin - administration & dosage; Bleomycin - therapeutic use; BOLD; brain metastases; Brain Neoplasms - drug therapy; Brain Neoplasms - secondary; Dacarbazine - administration & dosage; Dacarbazine - therapeutic use; Disease-Free Survival; Female; G-CSF; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - therapeutic use; Humans; Lomustine - administration & dosage; Lomustine - therapeutic use; Male; melanoma; Melanoma - drug therapy; Melanoma - secondary; Middle Aged; Neoplasm Staging; polychemotherapy; Remission Induction; Skin Neoplasms - drug therapy; Skin Neoplasms - pathology; Treatment Outcome; Vincristine - administration & dosage; Vincristine - therapeutic use
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hyi141

Background: Brain metastases are the most life-threatening among the secondary localizations of melanoma for their unresponsiveness to the surgical, radiotherapeutic and/or chemotherapeutic treatments. Methods: Accidentally, we observed a complete response (CR) in a patient undergoing chemotherapy with bleomycin, vincristine or Oncovin, CCNU or lomustine, dacarbazine (BOLD) regimen for metastatic melanoma including brain metastases, who was also treated with G-CSF to manage a concomitant leukopenia. After this observation, seven more patients with stage IV melanoma with brain metastases were treated with BOLD regimen repeated every 6 weeks with administration of G-CSF in the intervals. Results: Three patients presented CR (37.5%). Two patients stopped the treatment after two courses for evident progressive disease (25%). The other three patients showed stable disease (SD: 37.5%). Median duration of SD was 24 weeks. Among the eight patients, six (75%) achieved clinical benefit. Median time to progression was 8.5 months (range 0–74+ months). Median survival was 12.5 months (range 4–74+ months). Two patients are still alive and disease-free after 74 and 57 months, respectively. Conclusion: We believe that the brilliant CR, the long duration of the disease-free intervals and the long survival in at least three of eight patients should encourage further research on BOLD with G-CSF for the treatment of advanced melanoma.