Weekly paclitaxel and carboplatin may be an option for salvage chemotherapy in stage IV melanoma patients

Abstract

7572 Background Patients (pts) with metastatic melanoma (MM) have very few therapy options. Based on anecdotal reports of responses to Paclitaxel and Carboplatin (PC), several MM pts were treated with PC in our institution. Here we review our results with PC in a clinical practice setting. Methods Medical records were used to identify MM pts who had got PC, and data abstracted about pt characteristics and outcomes. Response determinations using clinical criteria were noted, and verified according to RECIST criteria, where possible. Results 17 pts (12 men and 5 women) started received weekly carboplatin (AUC=2) and Paclitaxel (100 mg/m2) between 5/2003 and 9/2004. Response evaluations were performed every 3 weeks. 1 pt was lost to follow up after 9 weeks of therapy. Pts were heavily pre-treated; with a mean of 1.8 (range 1–4) prior systemic therapies per pt. Mean duration of therapy was 8 weeks (range 3–21 w). 7 pts progressed (PROG) at the first evaluation, while a subset of pts appeared to have clear clinical benefit. 2 (12%) pts had a partial responses (PR) (including regression of liver metastases and ascites in 1 pt) and continue on therapy after a mean of 7.5 weeks of therapy. 9 (52%) pts had stabilization of disease (SD). In the SD group, the mean time to progression was 12 weeks, with 2 still on PC. Toxicity was tolerable, with only 1 pt needing to stop PC because of side effects to carboplatin. The median number of prior therapies was 2 in those with SD/PR and 2.5 in the PROG group. 4 pts continue on PC, and 3 are receiving other therapies after progressing on PC. Conclusion The main limitation of our study is its retrospective nature, with the presumed clinical bias in selection of pts. Yet, our clinical experience in MM pts appears to suggest that, when used in the salvage setting, weekly PC results in clear clinical benefit in a subset of pts. The degree of activity noted in our experience in this population is higher than may be predicted by previous prospective clinical trials using these drugs in relatively chemotherapy naïve pts (Hodi, et al, Am J Clin Oncol 25; (3) 283–6, 2002 and Zimpfer-Rechner, et al., Melanoma Res 13 (5),531–6, 2003). Further evaluation of weekly PC, alone or as a ‘backbone’ for other agents, should be considered. No significant financial relationships to disclose.