Tuesday, October 21, 2014

Biochem....eval of longterm results in melanoma

Folks still ask about "biochem"....it has positives and negatives like all melanoma treatments with roughly a 6% response rate....some docs still recommend it....so here is some data, recently tabulated...

Biochemotherapy with interleukin-2 for metastatic melanoma:  Long-term results in 100 patients
Abstract 9047 ASCO 2014  Minor, Kashani-Sabet, et al.

Retrospective single-institution review of 100 patients who began therapy between 9/30/2002 and 6/20/2006.  Median f/u = 9 years. Patients had O'Day treatment, similar to ECOG BC except Temozolomide is used for DTIC;  6 cycles of BC, not 4; decrescendo IL-2 dosing 36-18-9-9 miu/day dosing not based on BSA; and patients received maintenance in patient "pulse IL-2" 108miu/42 hours monthly for 6-18 months after BC.
28 patients are still alive, all NED.
One patient died due to a pulmonary embolus, one died from sepsis during BC, and 70 died for metastatic melanoma.
17 achieved CR with BC and never relapsed.
2 achieved PR, had surgery for solitary sites of residual disease, and are NED.
2 patients had late relapses over 3 years after BC.  The first received ipi and is now NED off therapy.  The second responded to ipi, progressed and is now NED on anti-PD1.
One patient received BS in 2005, relapsed in 2007, and is NED after multiple continuous treatments over 7 years with chemo, RT, surgery, ipi and vemurafenib.
Of the 28 patients alive, only the last two are currently receiving therapy.
CONCLUSION:  First-line decrescendo BC can give durable remissions, late relapses are uncommon.  Durable response to ipi may follow progression with BC.  Biochemotherapy should now be systematically studied as second line or consolidation therapy.

Hope it helps.  c

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