CVD

Metastatic melanoma (historical use; largely superseded by immunotherapy and targeted therapy). May be considered in patients who have progressed on or are ineligible for immune checkpoint inhibitors and BRAF/MEK inhibitors.

CVD regimen (every 21 days):
Cisplatin 20 mg/m² IV Days 1–4.
Vinblastine 1.6 mg/m² IV Days 1–4.
Dacarbazine 800 mg/m² IV Day 1.
Biochemotherapy variant: CVD + IL-2 + interferon-alpha (higher response rate but greater toxicity). Aggressive hydration required with cisplatin.

• Myelosuppression: All three agents cause bone marrow suppression. Monitor CBC before each cycle.
• Nephrotoxicity (Cisplatin): Requires aggressive IV hydration.
• Neurotoxicity: Cisplatin causes peripheral neuropathy and ototoxicity; vinblastine causes peripheral neuropathy and constipation.
• Nausea/Vomiting: Highly emetogenic. Requires multi-agent antiemetics.
• Hepatotoxicity: Dacarbazine may cause hepatic vein thrombosis in rare cases.
• Embryo-Fetal Toxicity: All agents are teratogenic.

Nausea/Vomiting (85%), Neutropenia (60%), Fatigue (65%), Peripheral neuropathy (35%), Alopecia (40%), Constipation (20%), Ototoxicity (15%), Nephrotoxicity (10%)

Adverse reaction frequencies reflect combination regimen data. Consult individual prescribing information for complete details.

CVD combines three mechanisms: Cisplatin forms intrastrand and interstrand DNA cross-links, inhibiting DNA synthesis. Vinblastine binds to tubulin, inhibiting microtubule polymerization and causing mitotic arrest. Dacarbazine is an alkylating agent that methylates DNA, causing strand breaks and inhibiting replication. The combination achieves multi-pathway cytotoxicity in melanoma cells.

• SWOG-8642 / NCI CVD trials — CVD regimen development and evaluation in metastatic melanoma. Phase II/III studies establishing CVD as historical standard.
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