Patient case: 60-year-old male with melanoma; genetic feature: NTRK1 rearrangement

Clinical trial: Combination Chemotherapy, Interferon Alfa, and Interleukin-2 in Treating Patients With Metastatic Melanoma

Summary: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Interferon alfa may interfere with the growth of the cancer cells. Interleukin-2 may stimulate a person's white blood cells to kill melanoma cells. It is not yet known which treatment regimen is more effective in treating melanoma.
  PURPOSE: Randomized phase II trial to compare the effectiveness of two regimens of combination chemotherapy plus interferon alfa and interleukin-2 in treating patients who have metastatic melanoma.

Detailed description: OBJECTIVES:
  -  Assess the rate of disease stabilization in patients with metastatic melanoma when treated with interferon alfa, dacarbazine, cisplatin, and interleukin-2.
  -  Assess toxicity, overall response rate, and response duration in these patients when treated with this regimen.
  OUTLINE: This is a randomized, multicenter study. Patients are stratified according to center. Patients are randomized to one of two treatment arms.
  -  Arm I: Patients receive dacarbazine IV over 1 hour and cisplatin IV over 3 hours on days 1-3. Patients also receive interferon alfa subcutaneously (SQ) on days 1-5 and interleukin-2 by continuous IV infusion on days 4-9. Treatment continues every 28 days for a maximum of 4 courses in the absence of disease progression or unacceptable toxicity.
  -  Arm II: Patients receive dacarbazine IV on day 1 and 22 every 28 days for 2 courses. Patients then receive treatment as in arm I for a maximum of 4 courses.
  Patients are followed every 2 months for 6 months, then every 3 months thereafter.
  PROJECTED ACCRUAL: A total of 42-90 patients will be accrued for this study.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed melanoma that is metastatic and unresectable
  -  Measurable, progressive disease (by physical exam and/or noninvasive imaging)
  -  No prior irradiation of indicator lesions
  -  No CNS metastases (confirmed by CT or MRI)
  PATIENT CHARACTERISTICS:
  Age:
  -  18 to 70
  Performance status:
  -  Karnofsky 60-100%
  Life expectancy:
  -  Greater than 3 months
  Hematopoietic:
  -  WBC at least 2,500/mm^3
  -  Platelet count at least 100,000/mm^3
  Hepatic:
  -  No serious hepatic disease
  Renal:
  -  Creatinine no greater than 1.65 mg/dL
  -  No serious renal disease
  Cardiovascular:
  -  No serious cardiac disease
  Pulmonary:
  -  No serious pulmonary disease
  Other:
  -  No organ allograft
  -  No autoimmune disease
  -  No uncontrolled infection
  -  No active peptic ulcer
  -  No hyper or hypothyroidism
  -  No requirement for corticosteroids
  -  No second malignancy except basal cell skin carcinoma or carcinoma in situ of the cervix
  -  Not pregnant or nursing
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  No prior immunotherapy with interleukin-2
  -  No prior interferon alfa in combination with cisplatin or dacarbazine
  Chemotherapy:
  -  No prior chemotherapy with cisplatin in combination with dacarbazine
  -  More than 3 months since prior chemotherapy
  Endocrine therapy:
  -  Not specified
  Radiotherapy:
  -  Prior radiotherapy allowed
  Surgery:
  -  Not specified

Relevance to patient case: not relevant