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

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), THE control of disseminated malignant melanoma by chemotherapy has generally been unsuccessful.¹ Dimethyl triazeno imidazole carboxamide (DTIC), the most effective chemotherapeutic agent for this disease, when administered either alone or in combination with other chemotherapeutic agents, has been associated with a definite anti-tumor response (≤550 per cent tumor regression) in only 14 to 25 per cent of patients. In general, the duration of these responses has been short, with a median survival of treated patients with disseminated melanoma of only 3.5 to 4.5 months.¹ There is evidence that the immunocompetence and prognosis of patients with cancer are closely related.^{2 3 4} We.