Utility of Chemotherapy for Metastatic Melanoma in the Contemporary Era and Experience with Modified Vinblastine–Cisplatin–Temozolomide at a Tertiary Care Center

Purpose: Chemotherapy can be a viable option for patients with relapsed-refractory melanoma (RRM) who do not have access to advanced treatments or clinical trials. We report our experience with a modified Vinblastine–Cisplatin–Temozolomide (mVCT) regimen in patients with RRM and barriers to their enrollment in clinical trials. Methods: We conducted a retrospective review of patients with RRM who received mVCT. The primary endpoint was overall response rate (ORR) following the last cycle. Secondary endpoints included the rate of complete response (CR), partial response (PR), stable disease (SD), clinical benefit rate (CBR), progression-free survival (PFS), intracranial (IC) PFS, (IC) CBR, (IC) RR, and toxicity. Results: Ten patients received mVCT for a median of 4.5 cycles (IQR: 3–6). Median follow-up was 20 months (IQR: 10.3–30.3). The ORR was 50% (CR-1, PR-4) and CBR was 70%. The median PFS was 7 months (IQR: 1.5–9.25). Among eight patients with brain metastasis, six underwent gamma-knife radiosurgery (GKRS); three achieved PR, and three had SD. Two patients without GKRS achieved CR, leading to an ICRR of 62.5% and an ICCBR of 100%. The median ICPFS was 7.5 months (IQR: 6–9.75). Median OS was 22 months (95% CI: 15.6–32.4). Four patients experienced grade ≥ 3 toxicities (fatigue in two, myelosuppression in two); two required dose reduction and one discontinued treatment. Two patients with PD later enrolled in phase 1 clinical trials. Brain metastasis (80%), immunotherapy-related toxicity (60%), acral/mucosal melanoma (50%), and social barriers (40%) were the major reasons for trial ineligibility. Conclusions: mVCT is an effective and well-tolerated regimen for patients with RRM and can serve as a bridge while they await access to advanced treatments or a clinical trial.