Melanoma remains a malignancy that is largely resistant to chemotherapy. Metastatic disease
responds poorly to the treatments used today with only 2 out of 30 drugs tested, DTIC and
nitrosoureas, showing response rates greater than 10%, and complete responses are rare.
DTIC-based regimen has been recognized as a standard chemotherapy for advanced melanoma, and
temozolomide demonstrated efficacy equal to that of DTIC and is an oral alternative agent
that also crosses the blood brain barrier. Randomized phase III trials have shown no survival
benefit of adding other agents (cisplatin, BCNU, and tamoxifen). Biochemotherapy is being
developed extensively with moderate improvement in the responsive rate (approximately 50%)
and is under evaluation in randomized trial to identify whether there is survival benefit to
this strategy, compared with chemotherapy alone. Recently, a randomized phase III study
comparing chemotherapy (cisplatin, dacarbazine, and tamoxifen) with biochemotherapy (the same
chemotherapy regimen plus high-dose IL-2 and interferon alfa) have shown 44% response rate
for biochemotherapy vs. 27% for chemotherapy. However, the tendency toward an increased
response rate in patients who received biochemotherapy did not translate into an increase in
overall survival, and there was, in fact, a trend for a survival advantage in patients
receiving chemotherapy alone (median survival: 10.7 vs 15.8 months). New agents (or
combinations) need to be developed for this refractory malignancy.
The purpose of this study is to determine the response rate and evaluate the toxicity of
disulfiram (DSF) in the treatment of Stage IV melanoma.
The advantages of using DSF in this phase I/II trial are the following:
- DSF has been used as a drug for many years for the treatment of alcoholism. Its
mechanism, pharmacokinetics, toxicity/tolerable dose are well known, and this drug is
relatively non-toxic by itself at therapeutic dose. Doses of greater than 3000mg/m2 can
cause reversible confusion.
- DSF can be taken orally; therefore, it is convenient to administer.
- DSF can penetrate the blood-brain barrier (unlike dacarbazine and many other
chemotherapy agents); therefore, it might have an active effect on CNS metastasis.
This study is designed to include women and minorities, but is not designed to measure
differences of intervention effect.