Temodar alone and in combination for melanoma – pro

Lay Summary: Temozolamide is guidelines recommended alone or with DTIC containing comibnations for melanoma.

The referenced guidelines says: “It is reasonable to use temozolomide at a dose of 200 mg/m2 orally for five days every four weeks as initial systemic treatment for patients with unresectable metastatic malignant melanoma.
The addition of moderate-dose interferon-alpha 2b has produced a significantly higher response rate than single-agent temozolomide in a large randomized phase III study. However, overall survival was not altered and grade 3 and 4 hematologic toxicities were higher with the combined treatment. At the present time, the addition of interferon-alpha to temozolomide is not recommended.
One randomized phase II study and six phase II studies have shown encouraging response rates when thalidomide is combined with temozolomide. However, dosing schedules of temozolomide in those studies differed from conventional prescribed doses and schedules. It is not clear whether the improved response rates were due to the small number of patients in the studies, the different dose schedules of temozolomide, or the addition of thalidomide. Further phase III studies are required to confirm whether there is a benefit associated with the combination of temozolomide and thalidomide. Therefore, it is not recommended that thalidomide be combined with temozolomide at this time.” This is also what NCCN recommends but it also notes dacarbazine combinations.

Danson S, Lorigan P, Arance A, et al. Randomized Phase II Study of Temozolomide Given Every 8 Hours or Daily with Either Interferon Alfa-2b or Thalidomide in Metastatic Malignant Melanoma. Journal of Clinical Oncology 2003;21:2551-2557.

Quirt I, Verma S, Petrella T, Bak K, Charette M, Melanoma Disease Site Group. Temozolomide for the treatment of metastatic melanoma: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Mar 20. 25 p. (Evidence-based series; no. 8-4). [38 references]

nccn.org, melanoma

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