Treatment of Brain Metastases From Melanoma

TO THE EDITOR: Agarwala et al have recently reported the results of a phase II study of temozolomide in melanoma brain metastases. The authors report a modest response rate of 6% among 151 patients, and an additional 26% of patients were reported to have experienced stable disease. I would like to point out some relevant details which are left out of this report. For instance it would be useful to describe the quality of temozolomide-induced responses observed by the authors, ie, the duration of objective responses (complete responses partial responses) as well as the length of stable disease category of responses. This is an essential piece of data, which must be reported in order for the readers to better assess the value of this drug to their patients In addition, the authors have made remarks indicating that temozolomide has more promising activity in melanoma brain metastases than any other chemotherapeutic agent. However, they fail to mention much higher response rates (20% to 25% compared with 6%) observed with fotemustine therapy as reported in multiple European trials. To provide a balanced view of the current literature on this subject, the authors should place temozolomide in the proper perspective.