Gerner et al recently described their experience in the treatment of disseminated melanoma with 5 (3,3 dimethyl 1 triazeno) imidazole 4 carboxamide (NSC 45388) and actinomycin D. During the course of the study cerebral hemorrhage suddenly developed in five patients despite the fact that previous studies had not revealed cerebral metastases. The complication occurred 3-4 wk after the last course of therapy. Although some patients with known central nervous system metastases have improved after treatment with NSC 45388, serious adverse effects possibly related to treatment should be anticipated. Every patient given this medication should undergo careful neurologic evaluation, perhaps including brain scan, in an attempt to anticipate central nervous system complications. In evaluating the combination of adriamycin (NSC 123127) and NSC 45388 in a variety of solid tumors, two patients with malignant melanoma and one with a soft part sarcoma had seizures after treatment with this combination of agents. (Vlachos - Athens)
