Cisplatin and carboplatin combination as second-line chemotherapy in dacarbazine-resistant melanoma patients

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Abstract
High-dose cisplatin regimens have been shown to be highly active in advanced melanoma patients but are associated with unacceptable side effects. In order to increase the platinum dose but avoid severe side effects, we treated 15 dacarbazine (DTIC)-resistant metastatic melanoma patients with a combination regimen of cisplatin (100 mg/m2) and carboplatin (200 mg/m2), two platinum analogues with a similar mode of action but a different toxicity pattern. After a mean follow-up period of 10.7 months (range 4–18 months), two patients (13.3%) achieved complete remission and two patients (13.3%) showed partial remission, giving an overall response rate of 26.4% (95% confidence interval [CI] 4.2–49%). Furthermore, three patients (20%; 95% CI 0–40.2%) experienced stable disease. The median duration of response was 7.1 months (95% CI 4.2–10.0 months), and the median overall survival was 12.5 months (95% CI 5.8–19.2 months), with eight patients still alive. The main side effects were haematological (leukopenia/thrombocytopenia World Health Organization [WHO] grade I–IV; anaemia WHO grade I–III), gastrointestinal (WHO grade I–III), neurological (WHO grade I–II) and renal (WHO grade I) toxicity. Nevertheless, except in one patient, side effects did not result in discontinuation of therapy. Despite the small number of patients treated in this preliminary study, we believe that combining cisplatin and carboplatin represents a novel, active and well-tolerated therapeutic option as second-line chemotherapy in DTIC-resistant advanced melanoma patients.