Cancer Treatment Today

Metastatic melanoma responds poorly to chemotherapy with the main drugs being temozolomide or dacarbazine after failure of immunotherapy or vaccination. However, Abraxane has been reported to have single agent activity. This response rate is higher than observed previously with paclitaxel or docetaxel suggesting that this formulation of paclitaxel may be more active than the conventional form.

Several phase II studies found Abraxane and paclitaxel to have some activity. The PC regimen was recently used as the comparator arm in two randomized, placebo-controlled, phase III trials testing PC vs PC plus sorafenib (Nexavar). In one of these trials involving patients who had received prior dacarbazine or temozolomide, patients who received PC alone had an ORR of 11%, median PFS of 17.9 weeks, and median OS of 42 weeks adn this is in line with the phase II study experience. There have not been guidelien recommendations or phase III trials.

Rao RD, Holtan SG, Ingle JN, et al. Combination of paclitaxel and carboplatin as second-line therapy for patients with metastatic melanoma. Cancer. 2006;106:375–382.

Hodi FS, Soiffer RJ, Clark J, et al. Phase II study of paclitaxel and carboplatin for malignant melanoma. Am J Clin Oncol. 2002;25:283–286.

Agarwala SS, Keilholz U, Hogg D, et al. Randomized phase III study of paclitaxel plus carboplatin with or without sorafenib as second-line treatment in patients with advanced melanoma (abstract 8510) J Clin Oncol. 2007;25(18S):474s.

P. Boasberg, S. Cruickshank, O. Hamid, S. O’Day, R. Weber, L. Spitler;  Nab-paclitaxel and bevacizumab as first-line therapy in patients with unresectable stage III and IV melanoma. J Clin Oncol 27:15s, 2009 (suppl; abstr 9061^)

Perez DG, Suman VJ, Fitch TR, et al. Phase 2 trial of carboplatin, weekly paclitaxel, and biweekly bevacizumab in patients with unresectable stage IV melanoma. Cancer. 2009;115:119-127.

Korn, EL et al. Meta-Analysis of Phase II Cooperative Group Trials in Metastatic Stage IV Melanoma to Determine Progression-Free and Overall Survival Benchmarks for Future Phase II Trials. J Clin Oncol. 26:527-534 (2008).
Gonzalez-Cao M, Viteri S, Diaz-Lagares A, et al. Preliminary results of the combination of bevacizumab and weekly paclitaxel in advanced melanoma. Oncology. 2008;74:12-16.

Hersh E, O’Day S, Gonzalez R, et al.Multicenter phase II study of ABI-007 (Abraxane) in previously treated and chemotherapy nave patients with metastatic malignant melanoma (MMM). Proceedings from the 23rd annual Chemotherapy Foundation Symposium. 2005. New York, NY. Abstract #27.

A phase II trial of carboplatin (C) and nab-paclitaxel (ABI-007-nab-P) in patients with unresectable stage IV melanoma: Final data from N057E1 (Abstract #9055-Poster Presentation)