TAMOXIFEN - IS IT USEFUL IN THE TREATMENT OF PATIENTS WITH METASTATIC MELANOMA

Purpose: We have attempted to review the data regarding the activity of tamoxifen (TAM) to clarify the role of this agent in the treatment of metastatic melanoma. Methods: Using the Melvyl Medline system, we identified recent reports describing the results of clinical trials that used TAM either as a single agent or in combination with other cytotoxic agents. Additionally, we reviewed the abstracts from the 29th Annual Meeting of the American Society of Clinical Oncology held in May 1993. Results: Numerous articles have reported an overall response rate of 47% (95% confidence limit, 39.25 to 54.75) when patients with metastatic melanoma are treated with the combination of dacarbazine (DTIC), carmustine (BCNU), cisplatin (DDP), and TAM (DBDT). Additionally, recent laboratory studies have reported that synergism between TAM and DDP is at least partially responsible for the success of this regimen. Conclusion: While TAM as a single agent is minimally active in treating patients with metastatic melanoma when it is combined with DTIC, BCNU, and DDP, a marked improvement in the overall response rate is observed. Although a prospective randomized trial has yet to be completed, it appears that this four-drug combination has a higher overall and complete response (CR) rate when compared with single-agent DTIC. In light of the relatively modest toxicity observed with this regimen, the combination of DBDT represents a reasonable alternative to single-agent DTIC as first-line therapy for patients with metastatic melanoma.