Immediate results of treatment of patients with metastatic uveal melanoma using isolated liver chemoperfusion. The first domestic experience

Introduction. Uveal melanoma is the most common primary intraocular tumor in adults. Despite some achievements in primary tumor treatment, 50% of patients develop distant metastases in various times (3 years to decades). Hematogenous spread is typical for uveal melanoma, and in 90% of the cases liver is the target. Median survival of patients with liver metastases is 4 to 9 months according to various researchers. And the result of treatment is extremely poor, unlike the results of skin melanoma treatment.The aim is to evaluate the immediate results of treatment of patients with uveal melanoma metastatic to the liver using isolated hepatic perfusion technique.Materials and methods. Considering a high risk of developing a metastatic liver disease in patients with uveal melanoma, local therapy is particularly interesting. This article describes the results of 10 metastatic uveal melanoma patients’ Isolated Hepatic Perfusion (IHP) Treatment. IHP was conducted using the standard methods with 100 mg of Melphalan for 60 min.Results and discussion. IHP treatment shows low complication rate. The data for response assessment is available on 9 out of 10 patients, because 10th patient received this treatment less than a month ago. Follow-ups a month after 9 patients underwent IHP showed an objective response to treatment in 6 patients (complete response in 1, partial response in 5 patients).Conclusion. The use of isolated liver chemoperfusion in a small group of patients according to the standard procedure allowed achieving an immediate response in 67% of cases.

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Intra-arterial perfusion-based therapies for regionally metastatic cutaneous and uveal melanoma

Melanoma Management ◽

10.2217/mmt-2019-0006 ◽

2019 ◽

Vol 6 (3) ◽

pp. MMT26 ◽

Cited By ~ 2

Author(s):

Kristy K Broman ◽

Jonathan S Zager

Keyword(s):

Uveal Melanoma ◽

Cutaneous Melanoma ◽

Hepatic Perfusion ◽

Arterial Perfusion ◽

Current State ◽

Limb Perfusion ◽

Melanoma Metastases ◽

Isolated Hepatic Perfusion ◽

In Transit ◽

Isolated Liver

Locoregional disease remains a challenging problem in cutaneous melanoma and uveal melanoma. Arterial-based chemoperfusion strategies enable regional therapy delivery with minimal systemic toxicity. Herein we discuss intra-arterial therapies for in-transit cutaneous melanoma of the extremity including hyperthermic-isolated limb perfusion and isolated limb infusion. We also discuss open (isolated hepatic perfusion) and percutaneous hepatic perfusion techniques for isolated liver metastases from uveal melanoma. We review the current state of knowledge with respect to indications, procedural techniques, outcomes and expected toxicities for intra-arterial chemoperfusion for locoregional melanoma metastases.

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Immune Checkpoint Blockade for Metastatic Uveal Melanoma: Patterns of Response and Survival According to the Presence of Hepatic and Extrahepatic Metastasis

Cancers ◽

10.3390/cancers13133359 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3359

Author(s):

Elias Koch ◽

Anne Petzold ◽

Anja Wessely ◽

Edgar Dippel ◽

Anja Gesierich ◽

...

Keyword(s):

Skin Cancer ◽

Uveal Melanoma ◽

Hepatic Metastasis ◽

Immune Checkpoint ◽

Objective Response ◽

Immune Checkpoint Blockade ◽

Checkpoint Blockade ◽

Response To Treatment ◽

Extrahepatic Metastasis ◽

The Impact

Background: Since there is no standardized and effective treatment for advanced uveal melanoma (UM), the prognosis is dismal once metastases develop. Due to the availability of immune checkpoint blockade (ICB) in the real-world setting, the prognosis of metastatic UM has improved. However, it is unclear how the presence of hepatic and extrahepatic metastasis impacts the response and survival after ICB. Methods: A total of 178 patients with metastatic UM treated with ICB were included in this analysis. Patients were recruited from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of hepatic metastasis, two cohorts were compared: patients with liver metastasis only (cohort A, n = 55) versus those with both liver and extra-hepatic metastasis (cohort B, n = 123). Data were analyzed in both cohorts for response to treatment, progression-free survival (PFS), and overall survival (OS). The survival and progression probabilities were calculated with the Kaplan–Meier method. Log-rank tests, χ2 tests, and t-tests were performed to detect significant differences between both cohorts. Results: The median OS of the overall population was 16 months (95% CI 13.4–23.7) and the median PFS, 2.8 months (95% CI 2.5–3.0). The median OS was longer in cohort B than in cohort A (18.2 vs. 6.1 months; p = 0.071). The best objective response rate to dual ICB was 13.8% and to anti-PD-1 monotherapy 8.9% in the entire population. Patients with liver metastases only had a lower response to dual ICB, yet without significance (cohort A 8.7% vs. cohort B 16.7%; p = 0.45). Adverse events (AE) occurred in 41.6%. Severe AE were observed in 26.3% and evenly distributed between both cohorts. Conclusion: The survival of this large cohort of patients with advanced UM was more favorable than reported in previous benchmark studies. Patients with both hepatic and extrahepatic metastasis showed more favorable survival and higher response to dual ICB than those with hepatic metastasis only.

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Isolated hepatic perfusion as a treatment for uveal melanoma liver metastases (the SCANDIUM trial): study protocol for a randomized controlled trial

Trials ◽

10.1186/1745-6215-15-317 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 19

Author(s):

Roger Olofsson ◽

Lars Ny ◽

Malin Sternby Eilard ◽

Magnus Rizell ◽

Christian Cahlin ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Liver Metastases ◽

Uveal Melanoma ◽

Study Protocol ◽

Controlled Trial ◽

Hepatic Perfusion ◽

Randomized Controlled ◽

Isolated Hepatic Perfusion

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Salvage radiotherapy for second oligo-recurrence in patients with breast cancer

Journal of Radiation Research ◽

10.1093/jrr/rrx066 ◽

2017 ◽

Vol 59 (1) ◽

pp. 58-66 ◽

Cited By ~ 1

Author(s):

Mari Miyata ◽

Takayuki Ohguri ◽

Katsuya Yahara ◽

Shinsaku Yamaguchi ◽

Hajime Imada ◽

...

Keyword(s):

Breast Cancer ◽

Objective Response ◽

Local Therapy ◽

Progression Free Survival ◽

Late Toxicity ◽

Distant Metastases ◽

Salvage Radiotherapy ◽

Severe Toxicity ◽

Term Survival ◽

Grade 3

Abstract A new concept designated ‘oligo-recurrence (OR)’ has been proposed, which indicates one to several distant metastases/recurrences in one or more organs, which can be treated with local therapy, after the primary site of the cancer has been controlled. The purpose of this study was to assess the efficacy and toxicity of salvage radiotherapy (RT) for the second OR of breast cancer. The second OR was defined as once-salvaged patients with OR who had a second failure that was also detected as the state of OR. Twenty-one patients with second OR were treated with salvage RT and were retrospectively analyzed. The sites of the second OR were locoregional recurrence in 7 patients and distant metastasis in 14 patients. Salvage RT was performed at a median total dose of 60 Gy. Nineteen (90%) patients had an objective response. The median overall survival and progression-free survival (PFS) times were 41 and 24 months after salvage RT for the second OR, respectively. The 3-year local (in-field) control (LC) rates were 93%. The toxicities were mild; acute toxicities ≥Grade 3 were seen in one patient with Grade 3 dermatitis, and no late toxicity ≥Grade 2 was observed. In conclusion, salvage RT for the second OR was able to achieve a better LC rate and longer PFS time without inducing severe toxicity, and therefore may be a potentially effective modality for inducing long-term survival in select patients.

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