Correspondence

Treatment of Brain Metastases of Malignant Melanoma with Temozolomide

N Engl J Med 2001; 345:621-622August 23, 2001

Article

To the Editor:

A 57-year-old man presented with an ulcerative, acral–lentiginous lesion on the sole of the left foot. Pathological examination showed a melanoma (Breslow depth, 2.2 mm; Clark level IV) without involvement of the surgical margins; the dissected ilioinguinal nodes showed micrometastases. A computed tomographic (CT) scan did not show any other lesion. The patient received interferon alfa, but two years later, plantar and ilioinguinal lesions recurred. They were removed twice in five months. Therapy with interferon alfa was stopped.

Two months later, a CT scan showed bilateral metastatic lesions in the lung. The patient was treated with dacarbazine, cisplatin, interferon alfa, and interleukin-2. After six cycles, a complete response was documented by total-body CT scanning, bilateral inguinal ultrasonography, and positron-emission tomography.

Two months later, confusion and epilepsy developed. A CT scan of the brain revealed multiple metastases (diameter, 0.5 to 1 cm), a finding confirmed by magnetic resonance imaging (Figure 1AFigure 1Magnetic Resonance Images of the Brain.). The patient was treated with oral temozolomide at a dose of 200 mg per square meter of body-surface area for five days every four weeks. After six cycles of the drug, magnetic resonance imaging showed that the brain lesions had disappeared (Figure 1B). The patient is still receiving therapy with temozolomide. He is in good health, without signs or symptoms of relapse.

Temozolomide, a new oral alkylating agent, is as active as dacarbazine in malignant melanoma.1 Temozolomide can cross the blood–brain barrier, and its concentration in the central nervous system is approximately 28 to 30 percent of its concentration in plasma.2 Another report has suggested the efficacy of temozolomide plus radiotherapy for the treatment of brain metastases of malignant melanoma.3 Our case shows that temozolomide alone can be effective in the treatment of such lesions.

Guido Biasco, M.D.
Maria A. Pantaleo, M.D.
Simona Casadei, M.D.
University of Bologna, 40138 Bologna, Italy
gbiasco@med.unibo.it

3 References

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   Agarwala SS, Reyderman L, Statkevich P, et al. Pharmacokinetic study of temozolomide penetration into CSF in a patient with dural melanoma. Ann Oncol 1998;9:Suppl 4:138-138 abstract.
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   Franke W, Neumann N, Richter-Hintz D, et al. Temozolomide -- a promising agent in the therapy of brain metastases in malignant melanoma. In: American Society of Clinical Oncology 36th Annual Meeting, New Orleans, May 20-23, 2000. Prog Proc Am Soc Clin Oncol 2000;19:575A-575A abstract.
   

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