Comparison of the combination of 1, 3‐bis(2‐chloroethyl)‐l‐nitrosourea (BCNU) and vincristine with two dose schedules of 5‐(3,3‐dimethyl‐l‐triazino) imidazole 4‐carboxamide (DTIC) in the treatment of disseminated malignant melanoma

One hundred twenty patients with inoperable metastatic malignant melanoma were randomly allocated to treatment with either a combination of BCNU 150 mg/m² and vincristine 2 mg/m² given every 30 days, or one of two regimens of DTIC: 300 mg/m²/day × 6 or 100 mg/m²/8 hours × 18 given every 30 days. Eight of the 51 (16%) patients who were originally treated with the BCNU and vincristine combination had 50% or more objective tumor regression, compared to 6 out of 25 (24%) patients treated with daily injections of DTIC, and 6 out of 21 (29%) patients treated with DTIC injections every 8 hours. The median duration of response to the BCNU and vincristine combination was 60 days, and the median duration of survival from initiation of treatment was 6.5 months in the responders and 3.3 months in the nonresponders. The median duration of response was 90 and 100 days for the daily and 8‐hour regimens of DTIC respectively, and the median duration of survival from commencement of treatment was 8.5 months for the responders and 3.5 months for the nonresponders. None of the 43 patients who failed to respond to the initial treatment program or whose disease progressed after initial improvement responded to the alternate treatment regimen.