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Persons who have metastatic malignant melanoma—skin cancer that has spread to other parts of the body—may be treated with chemotherapy drugs such as dacarbazine alone or a combination of dacarbazine, carmustine, cisplatin, and tamoxifen (an anti-estrogen drug). However, not all individuals will respond to this initial therapy, and those who do eventually experience progression of disease. Researchers at the Sylvester Comprehensive Cancer Center in Miami now report that a drug combination, chemotherapy with vinorelbine plus tamoxifen, may provide prolonged response rates in persons with metastatic melanoma.

Tamoxifen, an agent that inhibits estrogen, is not useful against metastatic melanoma by itself, but it has modest anti-cancer activity and helps to prevent resistance from developing to the chemotherapy drugs with which it is given. Tamoxifen is used with chemotherapy because it has few side effects and it allows the chemotherapy to be more effective against the cancer. Researchers in Miami sought to prolong the response and survival rates in individuals with metastatic melanoma, by combining tamoxifen with a drug called vinorelbine.

Thirty persons with advanced melanoma, which had spread to tissue surrounding the original cancer or had spread to distant parts of the body, received intravenous vinorelbine plus tamoxifen. Six persons had a partial response to this combination treatment, producing an overall response rate of 20%. Major parts of the body to respond to the treatment included the adrenal gland, lung, tonsil, and skin. Three persons had a prolonged response that lasted more than 1 year. These responses were superior to those previously achieved with dacarbazine alone (less than 20%) or recently with carmustine, dacarbazine, cisplatin, and tamoxifen (17%). The treatment side effects were mild and tolerable.

These findings suggest that vinorelbine may be effective in combination with other agents against metastatic melanoma, without the severe side effects associated with some other chemotherapy regimens. Further studies to compare vinorelbine plus tamoxifen directly to other treatments, as well as to test vinorelbine in combination with other agents such as dacarbazine or temozolomide, are needed. Persons who have metastatic melanoma may wish to talk with their doctor about the risks and benefits of participating in a clinical trial in which vinorelbine or other new treatments are being studied. Other sources of information on ongoing clinical trials include a comprehensive, easy-to-use service provided by the National Cancer Institute

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Cancer, Vol 88, No 3, pp 548-589, 2000)

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