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Prognostic factors in metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy
The Oncologist, 10/30/09

Minor DR et al. – With no U.S. Food and Drug Administration–approved standard therapy other than high-dose interleukin-2 and dacarbazine for metastatic melanoma, biochemotherapy has shown promise, with long-term survival in selected patients. We felt that the study of prognostic factors would determine which patients might benefit from this intensive therapy. Metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy who have either a normal LDH level or skin or nodes as one of their metastatic sites may have durable remissions of their disease.

Methods

135 consecutive patients with metastatic melanoma treated with decrescendo biochemotherapy followed by maintenance immunotherapy over 5 years retrospectively studied to determine most important prognostic factors for both OS and PFS
PFS curves showed no relapses after 30 months, so remissions were durable

Results

Median overall survival (OS) time 16.6 months, with 1-year and 5-year survival rates of 70% and 28%, respectively
PFS curves showed no relapses after 30 months, so remissions were durable
For OS, performance status score of zero, normal lactate dehydrogenase (LDH) level, stage M1a, and nonvisceral sites of metastasis were favorable factors
The group with normal LDH levels and skin or nodes as one of their metastatic sites had relatively good prognosis, with median survival time of 44 months and estimated 5-year survival rate of 38%
Conversely, patients with elevated LDH level without skin or nodal metastases had poor prognosis, with no long-term survivors

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