Chemoimmunotherapy of Disseminated Malignant Melanoma with Dimethyl Triazeno Imidazole Carboxamide and Bacillus Calmette-Guérin

Abstract

Eighty-nine patients with disseminated malignant melanoma were treated with a combination of dimethyl triazeno imidazole carboxamide (DTIC) administered intravenously and bacillus Calmette–Guérin (BCG) administered by scarification. The results were compared to those in a comparable retrospective group of 111 patients treated with DTIC alone. Metastatic areas regional to BCG immunization showed an augmented response to chemotherapy. Thus, chemoimmunotherapy-treated patients with lymph-node metastasis had a remission rate of 55 per cent compared to one of 18 per cent for patients treated with chemotherapy alone (p = 0.025). The duration of remissions and survival was significantly longer for patients (both nonvisceral and visceral metastases) treated with chemoimmunotherapy than for those treated with chemotherapy alone (p = 0.05, 0.001, respectively). A good prognosis was associated with immunocompetence before treatment or an increase in immunocompetence during treatment. Chemoimmunotherapy was well tolerated without serious morbidity. Further trials of chemoimmunotherapy are indicated in patients with disseminated malignant melanoma as well as other disseminated solid tumors. (N Engl J Med 291: 592–597, 1974)