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Outpatient Biochemotherapy With Interleukin-2 and Interferon Alfa-2b in Patients With Metastatic Malignant Melanoma: Results of Two Phase II Cytokine Working Group Trials

From the Karmanos Cancer Institute, Wayne State University, Detroit, MI; Beth Israel Deaconess Medical Center, Boston, MA; University of Illinois at Chicago and Loyola University, Chicago, IL; University of Texas, San Antonio, TX; City of Hope National Medical Center, Duarte, CA; New York Medical College, Bronx, NY; University of Arizona, Phoenix, AZ; and University of Pittsburgh, Pittsburgh, PA.

Address reprint requests to Lawrence E. Flaherty, MD, Division of Hematology and Oncology, 516-Hudson, Harper Hospital, 3990 John R, Detroit, MI 48201; email: flaherty{at}karmanos.org

PURPOSE: The Cytokine Working Group performed a randomized phase II trial of two outpatient biochemotherapy regimens to identify an outpatient regimen with high antitumor activity and less toxicity than inpatient regimens which might be compared with chemotherapy or inpatient biochemotherapy regimens in future phase III trials.

PATIENTS AND METHODS: Eighty-one patients with metastatic malignant melanoma received dacarbazine 250 mg/m²/d intravenously (IV) and cisplatin 25 mg/m²/d IV on days 1, 2, and 3, plus interferon (IFN) alfa-2b 5 mU/m² subcutaneously (SC) on days 6, 8, 10, 13, and 15, given every 28 days. Interleukin-2 (IL-2) was given daily on days 6 to 10 and 13 to 15. In group 1, IV IL-2 was given at 18.0 MU/m², and in group 2, SC IL-2 was given at 5.0 mU/m².

RESULTS: In group 1 (IV IL-2), there were five complete responses (CRs) and 11 partial responses (PRs) among 44 patients (objective response rate [ORR], 36%; 95% confidence interval [CI], 22% to 51%). In group 2 (SC IL-2), there was one CR and five PRs among the 36 patients (ORR, 17%; 95% CI, 4% to 29%). The median survival was 10.7 months in group 1 and 7.3 months in group 2. Eleven patients in group 1 and four patients in group 2 remain alive as of the last follow-up. Toxicities in both groups were similar. No patient required hospitalization for neutropenic fever.

CONCLUSION: Biochemotherapy has activity in these outpatient regimens with acceptable toxicity. The antitumor activity observed with the IV IL-2 regimen seems similar to that of inpatient biochemotherapy regimens. If inpatient biochemotherapy regimens develop an established role in the management of melanoma, future phase III trial comparisons with this outpatient IV IL-2 regimen would be appropriate.

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