Isolated limb perfusion for locally advanced melanoma in the immunotherapy era |
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| Affiliation: | 1. The Institute of Cancer Research, Chester Beatty Laboratories, 237 Fulham Road, London, SW3 6JB, UK;2. The Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066, CX, Amsterdam, Netherlands;3. Sarcoma and Melanoma Unit, Royal Marsden Hospital NHS Trust: Royal Marsden NHS Foundation Trust, 237 Fulham Road, London, SW3 6JJ, UK;4. Melanoma and Sarcoma Unit, Department of Academic Surgery Royal Marsden Hospital, London, SW3 6JJ, UK;1. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;2. Department of Surgery, ETZ (Elisabeth-TweeSteden) Hospital, Tilburg, the Netherlands;3. Department of GROW, School for Developmental Biology & Oncology, Maastricht University, Maastricht, the Netherlands;1. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan;2. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan;1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore;2. Ministry of Health Holdings, Singapore;3. Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore;4. Duke-National University of Singapore Medical School, Singapore;1. Department of Medical and Surgical Sciences (DIMEC), IRCCS Sant’Orsola-Malpighi, Obstetric and Gynecologic Unit, University of Bologna, Bologna, Italy;2. Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France;3. INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France;4. INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France;1. Department of General, Gastrointestinal, Oncologic Surgery and Transplantology, I Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland;2. Department of General, Oncologic and Geriatric Surgery, III Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland;3. Centre of Oncology Maria Sklodowska Curie Memorial Institute, Department of Surgical Oncology Krakow, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland |
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| Abstract: | ![]()
BackgroundPrior to the advent of effective systemic therapy for melanoma, isolated limb perfusion (ILP) was the most effective local treatment for advanced in-transit melanoma (ITM). However, many patients who are now treated by ILP will have received prior immunotherapy. We sought to compare response rates to ILP in patients who had previously received immunotherapy compared to immunotherapy naive patients.Materials and methodsAll patients who underwent ILP for ITM between January 2015 and July 2020 for melanoma were identified retrospectively from two tertiary institutions. Surgical morbidity and oncologic outcomes were compared between immunotherapy naive and immunotherapy pre-treated patients.Results97 perfusions were performed for melanoma. Of those, 18 patients had undergone prior immunotherapy. There were no differences in clinicopathological characteristics or perioperative outcomes between cohorts. Surgical morbidity and local toxicity were similar between both cohorts. Patients who underwent immunotherapy prior to ILP had significantly decreased complete response (CR) rates compared with immunotherapy-naïve (6% vs 47%, p = 0.0018) and a significantly decreased overall survival (OS) and distant progression free survival (DPFS) (p = 0.0031 and p = 0.0006 respectively). There was no difference in overall response (OR), partial response (PR), stable disease (SD), progressive disease (PD) and local progression free survival (LPFS) between cohorts.ConclusionOncological outcomes and complete response rates are worse in patients who have received immunotherapy prior to ILP compared with immunotherapy naïve patients. Despite this, ILP is still a valuable second line treatment for local control in patients who have multiple, bulky and/or recurrent ITM post immunotherapy. |
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| Keywords: | Melanoma Immuno-therapy Isolated limb perfusion Response |
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