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A Comparative Study of 1-(2-Chloroethyl)-3-cyclohexyl-1-nitrosourea (NSC 79037) and Imidazole Carboxamide (NSC 45388) with Vincristine (NSC 67574) in the Palliation of Disseminated Malignant Melanoma¹

Division of Clinical Oncology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55901

The effects of 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) (NSC 79037) were compared to those of a combination of imidazole carboxamide (NSC 45388) and vincristine (NSC 67574) as treatment in 37 patients with disseminated malignant melanoma.

Objective remissions were observed in 4 of 18 patients who received the combination as primary therapy compared to 1 of 19 remissions after CCNU. Subsequent use of the alternate regimen resulted in 1 clinical remission in 11 cases with the combination and no remissions with CCNU among 7 cases. Thus, secondary therapy with either regimen was ineffective.

The toxicity observed with imidazole carboxamide and vincristine included hematological depression with leukocyte counts below 3,000/cu mm in 9 of 29 patients and platelet counts less than 100,000/cu mm in 8 of 29 patients, as compared to 8 of 26 patients with leukocytes below 3,000 and 13 of 26 patients with platelets less than 100,000 utilizing CCNU. Nausea and vomiting occurred in all patients who received the combination and in 17 of 26 patients who received CCNU. Parenteral fluids were not necessary in either group. Neurological toxicity including paresthesias and loss of deep tendon reflexes occurred in 9 of 29 patients after the combination therapy but was not observed with CCNU therapy. Moderate to severe hair loss occurred in 7 of 29 patients who received the combination therapy but did not occur with CCNU. One patient developed a papular dermatological reaction after imidazole carboxamide and vincristine.

¹ This investigation was supported in part by Research Grant 3 PO1 CA10731-O1S1 from NIH, USPHS.

Received 6/ 6/72. Accepted 8/ 1/72.