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Temozolomide for the Treatment of Brain Metastases Associated With Metastatic Melanoma: A Phase II Study

From the University of Pittsburgh Cancer Institute, Pittsburgh, PA; the Royal Marsden, National Health Service Trust, London, and Christie Hospital, National Health Service Trust, Withington, Manchester, United Kingdom; Clinique Dermatologique, Nantes Cedex, France; Virchow Klinikum, Universitat zu Berlin, Berlin, Germany; New England Medical Center, Boston, MA; Hospital Sirio-Libanês, São Paulo, Brazil; Agioi Anarguroi Hospital, Athens, Greece; and Netherlands Cancer Institute, Amsterdam, the Netherlands

Address reprint requests to Sanjiv S. Agarwala, MD, Division of Hematology Oncology, University of Pittsburgh Medical Center Pavilion, 5150 Centre Ave, Pittsburgh, PA 15232; e-mail: agarwalass{at}msx.upmc.edu

PURPOSE: Temozolomide is a well-tolerated oral alkylating agent with activity in the CNS. A multicenter, open-label, phase II study was conducted to assess the safety and efficacy of temozolomide in patients with brain metastases from metastatic melanoma (MM) who did not require immediate radiotherapy.

PATIENTS AND METHODS: Eligible patients had histologically confirmed MM to the brain, and no prior radiotherapy or radiosurgery for brain metastases. Previously untreated patients received temozolomide at 200 mg/m²/d x 5 days; previously treated patients received 150 mg/m²/d x 5 days every 28 days. Treatment continued for 1 year or until disease progression or unacceptable toxicity.

RESULTS: Of 151 patients enrolled, 117 had received no prior systemic chemotherapy, and 34 had received prior chemotherapy for MM. Among previously untreated patients, 25% had more than four brain lesions, eight (7%) achieved an objective response (one complete and seven partial), and 34 (29%) had stable disease in brain metastases. Median overall survival was 3.5 months. Among previously treated patients, 21% had more than four brain lesions, one had a partial response, and six (18%) had stable disease in brain metastases. Median overall survival was 2.2 months. Temozolomide was well tolerated, with four (3%) patients discontinuing because of adverse events. Grade 3/4 hematologic toxicities included thrombocytopenia (3%), neutropenia (2%), and leukopenia (1%). Headache (9%) and vomiting (8%) were the most common nonhematologic grade 3/4 adverse events.

CONCLUSION: Temozolomide was well tolerated and demonstrated activity in the treatment of brain metastases from MM. Further evaluation of temozolomide combination therapy is warranted.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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