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Treatment of Brain Metastases From Melanoma

St Luke's Episcopal Hospital, Houston, TX

To the Editor:

Agarwala et al¹ have recently reported the results of a phase II study of temozolomide in melanoma brain metastases. The authors report a modest response rate of 6% among 151 patients, and an additional 26% of patients were reported to have experienced stable disease.

I would like to point out some relevant details which are left out of this report. For instance it would be useful to describe the quality of temozolomide-induced responses observed by the authors, ie, the duration of objective responses (complete responses + partial responses) as well as the length of stable disease category of responses. This is an essential piece of data, which must be reported in order for the readers to better assess the value of this drug to their patients

In addition, the authors have made remarks indicating that temozolomide has more promising activity in melanoma brain metastases than any other chemotherapeutic agent. However, they fail to mention much higher response rates (20% to 25% compared with 6%) observed with fotemustine therapy as reported in multiple European trials.^2-5 To provide a balanced view of the current literature on this subject, the authors should place temozolomide in the proper perspective.

Author's Disclosures of Potential Conflicts of Interest

The following author or their immediate family members have indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. Consultant: Sewa S. Legha, Schering Plough Oncology. Honoraria: Sewa S. Legha, Schering Plough Oncology. For a detailed description of these categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest' section of Information for Contributors found in the front of every issue.

REFERENCES

1. Agarwala SS, Kirkwood JM, Gore M, et al: Temozolomide for the treatment of brain metastases associated with metastatic melanoma: A phase II study. J Clin Oncol 22:2101-2107, 2004[Abstract/Free Full Text]

2. Jacquillat C, Khayat D, Banzet P, et al: Final report of the French multicenter phase II study of the nitrosourea totemustine in 153 evaluable patients with disseminated malignant melanoma including patients with cerebral metastases. Cancer 66:1873-1878, 1990[CrossRef][Medline]

3. Jacquillat C, Khayat D, Banzet P, et al: Chemotherapy by fotemustine in cerebral metastases of disseminated malignant melanoma. Cancer Chemother Pharmacol 25:263-266, 1990[CrossRef][Medline]

4. Merimsky O, Inbar M, Reider-Groswasser I, et al: Fotemustine with or without dacarbazine for brain metastases of malignant melanoma. Eur J Cancer 27:1066, 1991

5. Khayat D, Giroux B, Berille J, et al: Fotemustine in the treatment of brain primary tumors and metastases. Cancer Investigation 12:414-420, 1994[Medline]

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  Sanjiv S. Agarwala
  JCO 2005 23: 3155-3156 [Full Text]

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