Nitrosoureas in the management of disseminated malignant melanoma.

Three of the nitrosoureas, BCNU, CCNU, and methyl-CCNU, have displayed significant antitumor activity in patients with disseminated malignant melanoma with none clearly superior to the others, although direct comparison in clinical trials was not accomplished. Response rates to various combinations of these nitrosoureas seem a bit higher, but not dramatically so, when compared to the single-agent response rates, although again this cannot be stated with certainty since direct comparisons were not accomplished. There appears to be no therapeutic advantage to the utilization of any one of the nitrosoureas over the others, but oral administration, as is available for CCNU and methyl-CCNU, is a distinct advantage to the patient and to the clinician. The response rates are, for the most part, rather consistent for the various studies reported in this paper, and these response rates leave a great deal of room for improvement. Secondary therapy utilizing the nitrosoureas was singularly unsuccessful in most of the reported clinical trials. It is refreshing, however, to have agents which have shown activity, although modest, in this most refractory of neoplasms.