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  • 1. M.V. LOMONOSOV MOSCOW STATE UNIVERSITYFACULTY OF BASIC MEDICINE COMPARISON OFPOLY- CHEMOTHERAPY (CVD regimen) & THE SAME CHEMOTHERAPY (CT) PLUS INTERFERON-2a IN METASTATIC MELANOMA Student: Dr. Kyaw Thura ZawScientific Supervisor :Prof. Dr. Lev DemidovN.N. BLOKHIN CANCER RESEARCH CENTREMoscow ,2010

2. INTRODUCTION

  • Malignant melanoma is a neoplasm of melanocytesor of the cells that develop from melanocytes.
  • Melanoma is showing a rapid worldwide rise in incidence, with a yearly increase of about 5% and a frequent occurrence in young adults . Even though surgery represents the cure in the early phase of disease, the prognosis in patients with metastatic melanoma remains very poor, with a median survival ofabout 69 months .

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  • Melanoma signaling cascades MAPK and PI3K. The MAPK pathway is hyperactivated in melanomas, mainly due to activating mutations in either the NRAS or BRAF genes .

4. Epidemiology

  • Frequency: Queensland, Australia, has the highest incidence of melanoma in the world, approximately 57 cases / 100,000 people / year. Israel also has one of the highest incidences,approximately 40 cases / 100,000 people annually.
  • Incidence: Increasing rapidly worldwide, and faster rate than that of any other cancer except lung cancer in women. Melanoma is notorious for affecting young and middle-aged people.

5. Race Melanoma is more common in whites than in blacks and Asians. The rate of melanoma in blacks is estimated to be1/120that of whites.Sex Melanoma is slightly more common in men than women (1.2:1). Melanoma is the 5th most common malignancy in men and the 6th most common malignancy in women, accounting for 5% and 4% of all new cancer case. respectively. 6. Risk Factors

  • Sun Exposure and Sun beds
  • Nevi
  • Skin Pigmentation
  • Solar Elastosis and Solar Keratoses
  • Gene Alterations
  • Somatice Alterations
  • Common Low Penetratace Genes

7. A=AsymmetryB=Border (irregular) C= Color D= Diameter ABCD Properties of Radial Melanomas 8. A 1.5-cm melanoma with characteristicasymmetry, irregular borders, and color variation. 9. Factors Predicting the Outcome of Response of Treatment

  • Good performance status
  • Soft tissue disease or only a few visceral metastases
  • Age younger than 65 years
  • No prior chemotherapy
  • Normal hepatic and renal function
  • Normal CBC count
  • Absence of CNS metastases

10. AIM OF STUDY To Study and Compare thePoly-chemotherapy (CVD regimen) & the Same Chemotherapy(CT)plus Interferon - 2 a in Metastatic Melanoma. 11. Objectivesof Study

  • To study the response rate of poly chemotherapy (CVD regimen) and the same chemotherapy (CT) plus interferon-2a in metastatic melanoma.
  • To study the effect of combine Chemotherapy (CVD) in metastatic melanoma.
  • To study Bio chemotherapy not more rather than Chemotherapy alone.

12. Materials and Methods 13. Patients Characteristics CVD PCVD+IFN P Age , median (min-max) 55 (35-65) P0.25 2 10 P>0.10 7 P>0.30 Metastatic sites Skin 4 P>0.25 6 P>0.10 Lymph node 10 P>0.70 9 P>0.25 Lungs 9 P=1.00 9 P=1.00 Liver 9 P>0.10 6 P>0.10 Other 3 P>0.10 0 P>0.20 Number of Metastases 1 1 P>0.10 4 P>0.10 2 8 P>0.70 7 P>0.70 3 6 P>0.25 4 P>0.25 14. Treatment Schedules

  • The treatment regimen A consisted ofDacarbazine : 800mg/m2 IV day 1,Vinblastine : 1.6 mg/m2 IV days 1-5, andCisplatin :20 mg/m2 IV days 1-4(CVD) . The cycle was repeated on day 22.
  • ThetreatmentregimenBconsistedofCVDchemotherapyplus IFN alpha-2a1.5x10 6IU/m2 days 1-10. The total number of cycles/day was 6atthemost .

15. Response of Therapy 16.

  • CR: Complete Response, PR: Partial Response ,
  • SD: Stable Disease
  • PD: Progressive Disease.

COMPARISON BETWEEN THE RESULT OF CVD AND CVD+IFN 17. Overall survival. Heavy line represents CVD + IFN group; Fine line represents CVD group ; No. of death /Total No. Average survival Survival Median CVD+IFN 8/15 13.51(9.7;17.3) 12.0(9.9;14.1) CVD 7/15 10.75(9.1;12.4) 12.0(7.8;16.2) 18. CONCLUSIONS

  • ResponseratewasthehighestbestinCVD+IFNgroup(6/15)compared to CVD (4/15) , but the difference was not significant.
  • Combined Chemotherapy(CVD) and Biochemotherapy (CVD+IFN) in which, all showed some activity in Metastatic Melanoma.
  • The best responding metastatic siteswere the lymph nodes all patients experienced mild adverse effects. No treatment-related deaths occurred. The median survival was 12monthsinCVD+IFN,CVDrespectively.

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