Temozolomide plus cisplatin as first-line treatment for advanced or metastatic mucosal

melanoma

F. Aldaco Sarvide1 , H. Millán2 , M.G. Cervantes Sanchez3 1 Oncology Department, Centro

Medico Nacional 20 de Noviembre ISSSTE, Mexico City, Mexico; 2 Medical Oncology,
FUCAM, Mexico City, Mexico; 3 Medical Oncology Department, ISSSTE - Centro Médico
Nacional 20 de Noviembre, Mexico City, Mexico

Background: Mucosal melanomas are a rare cancer with poor prognosis; biology differs
significantly from cutaneous melanoma. Standard treatment for advanced disease has not
been established; however, checkpoint inhibitors and targeted agents seems to be good
option, unfortunately, at our institution have not been approved for use in mucosal
melanomas. Temozolomide plus Cisplatin as adjuvant treatment improve outcomes versus
HDI in pts with mucosal melanomas (Lian B, et al J Clin Oncol 2018 36:15_suppl, 9589-
9589). Here, we report our experience with Temozolomide plus Cisplatin in pts with
advanced or metastatic mucosal melanomas as first-line treatment.

Methods: We retrospectively collected data from 2015 to 2020. Pts treated at our
institution with Cisplatin: 25 mg/m2 d1-3 q3-4w up to 4-6 cycles plus Temozolomide: 200
mg/m2 d1-5 q3-4w up to 24 cycles. Inclusion criteria: mucosal melanomas nonresectable
stage III or metastatic disease, first-line treatment, complete medical record and ECOG 0-
2.

Results: 20 pts were included. Female 70%, male 30%, median age 66.1 (43-86), ECOG 0-1
80%, Stage IV 70%, Stage III 30%, nasal cavity 55%, oral cavity 5% (H&N 60%), vulvovaginal
30%, anorectal 10%. Number of lesion sites; 2-3: 40%, 1: 60%. Lung metastases 50 %, liver
metastases 15%, CNS metastases 5%. LDH > ULN 65%. Treatment: Mean number of cycles;
cisplatin: 4 (1-6), temozolomide: 7 (1-24). Efficacy among evaluable pts; median PFS: 5.5
months (m), PFS 12m: 45%, median OS: 15.6m, OS 12m: 55%, OS 24m: 35%. ORR 35% (PR
25%, CR 10%), SD 55%, PG 15%. Toxicity grade 1-2: asthenia 55%, anaemia 25%,
neutropenia 10%, platelets 15%, creatinine 14%, ALT/AST 10%, neuropathy 25%, emesis
25%. Toxicity grade 3: creatinine 5%, neuropathy 5%, emesis 5%. Toxicity grade 4-5: 0%.
Data corroborate prior findings (Lian B, data) and confirm antitumor activity of
temozolomide plus cisplatin in pts with mucosal melanomas. The study is limited by its
small size sample, retrospective data, one arm and unknow driver mutations.

Conclusions: Cisplatin plus temozolomide showed activity in mucosal melanomas and

could be considered as a reasonable therapeutic option in patients without access or
failure to checkpoint inhibitors or targeted agents.

Legal entity responsible for the study: The authors.

Funding: Has not received any funding.

Disclosure: F. Aldaco Sarvide: Non-Financial Interests, Personal, Advisory Board, Invited
Speaker: MSD, Bristol Myers Squibb, Amgen; Non-Financial Interests, Personal, Invited
Speaker: Novartis; Non-Financial Interests, Personal, Advisory Board: Pfizer. All other
authors have declared no conflicts of interest.