A phase II trial of biochemotherapy with cisplatin, vinblastine, dacarbazine, interleukin-2, interferon, and digoxin in melanoma matients

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Background: Patients with stage IV metastatic melanoma have limited treatment options. Epidemiological studies have demonstrated that there is a lower death rate from breast cancer in patients who are on digoxin therapy (6%) when compared with patients who are not on digoxin therapy (34%). Recent in vitro studies have shown that digoxin inhibits growth and causes apoptosis in multiple cell lines including breast cancer cells (MCF-7), non-small cell lung cancer cells, HeLa cells, renal adenocarcinoma cells (TK-10), neuroblastoma cells, and prostate cancer cells. In addition digoxin enhances the efficacy of chemotherapy against melanoma cells in vitro. Consequently, the addition of digoxin may augment the cytotoxic effects of bio-chemotherapy against stage IV melanoma. Methods: Twenty-seven patients with stage IV melanoma without CNS metastasis with a median age of 51 years (25–69), were enrolled in this open label phase II clinical trial. ECOG performance status was 0 to 1. Patients had normal cardiac, pulmonary, renal and liver function tests. Patients received digoxin 0.25 mg daily throughout all cycles. Patients were hospitalized in ICU for 5 days to receive the therapy and supportive care. Treatment schedule: dacarbazine, IV, 800 mg/m2 on day 1; cisplatin, IV, 20 mg/m2 on days 1–4; vinblastine, IV, 1.2 mg/m2 on days 1–4; IL-2, IV over 24 hours, 9 M IU/m2 on days 1–4; interferon, SC, 5 MU/m2 on days 1–5. After completing 2 cycles (28 days per cycle) patients were evaluated for response by CT and/or FDG-PET imaging studies. Patients who experienced a SD, PR, or CR then completed 2 more cycles of this therapy. There was no treatment related mortality. Results: Seven patients achieved CR (25.9%), five patients had a PR (18.5%), and six patients had a SD (22.2%). The overall clinical benefit was 66.6%. Nine patients (33.3%) experienced progressive disease and were taken off the protocol. Eleven patients (40%) are alive and sixteen patients (60%) have died. Conclusions: Our preliminary data demonstrate that the addition of digoxin to bio-chemotherapy may have a synergistic effect on patients with melanoma. Accrual to this trial is on-going and final overall survival and progression free survival will be evaluated in the future.

No significant financial relationships to disclose.

Impact of race and ethnicity on ischemic stroke. The University of California at San Diego Stroke Data Bank

BACKGROUND AND PURPOSE

As the US minority population continues to grow, increasing numbers of nonwhite citizens are at risk for stroke. A better understanding of how ischemic stroke differs in the minority populations may lead to more effective clinical management.

METHODS

We prospectively evaluated 542 consecutive patients (416 whites, 71 Mexican Americans, 55 blacks) presenting to the University of California at San Diego Medical Center or the San Diego Veterans Affairs Hospital with presumed acute ischemic stroke or transient ischemic attack.

RESULTS

Whites had a higher proportion of transient ischemic attacks (32% versus 18% and 17% for blacks and Mexican Americans, respectively) and had the lowest prevalence of diabetes mellitus (17% versus 29% and 40% for blacks and Mexican Americans, respectively). Mexican Americans had higher initial serum glucose levels (178 versus 133 and 131 mg/dL for whites and blacks, respectively). Blacks were youngest (average age, 56 years). There were no differences among the groups in the prevalence of prior stroke, hypertension, myocardial infarction, or smoking; initial systolic blood pressure, serum cholesterol levels, and functional deficit also were similar. Although it did not reach statistical significance, there was a trend toward relatively late presentation in the black stroke subpopulation: only 53% of blacks (compared with 73% of both Mexican Americans and whites) reached medical attention within 24 hours of stroke onset. All groups had similar diagnostic evaluations and functional outcome at 1 week. With the exception of a higher frequency of stroke of unknown cause in Hispanics, the distributions of stroke etiologies did not differ significantly among the groups.

CONCLUSIONS

These data suggest that there are significant clinical differences in populations with ischemic stroke and transient ischemic attack that are related to race and ethnic origin, but in our population these differences did not include the extent of diagnostic evaluation undertaken or stroke severity.