In a nutshell
The authors aimed to determine the effect of hepatic intra-arterial (HIA) compared to intravenous (IV) fotemustine (Muphoran) treatment in patients with liver tumors from uveal melanoma.
Some background
Uveal melanoma is a rare form of cancer that occurs in the eye. In 5% of patients this will lead to cancer spread into other parts of the body, usually within 3 years after treatment is first received. The liver is the first organ the cancer spreads to. HIA is a treatment option for patients with uveal melanoma that has spread to the liver.
HIA is a form of treatment that delivers chemotherapy (chemical drugs used to treat cancer) directly into the liver through the main blood vessel that supplies blood to the liver. Chemotherapy can also be given through an IV (drug is delivered to the target site through a tube inserted into the vein). In both cases fotemustine (chemotherapy drug) can be used with successful results.
Methods & findings
The aim of this study was to determine whether HIA or IV fotemustine was more successful in treating liver tumors in uveal melanoma patients.
171 patients were used in this study with an average follow-up time of 5-6 years. 86 patients were treated with HIA and 85 patients were treated with IV fotemustine. 155 patients died and 16 were still alive at the end of this study.
Overall survival (patients who did not die from melanoma following treatment) was 14.6 months in the HIA group compared to 13.8 months in the IV group. At 2 years 19.2% survived in the HIA group compared to 20.2% in the IV group.
10.5% of patients in the HIA group responded to treatment compared to 2.4% in the IV group. The time from treatment until cancer progression was 9 months in the HIA group compared to 8.3 months in the IV group. 38.4% of patients in the HIA group had stable disease (tumor did not progress or shrink, but remained the same size) compared to 51.8% in the IV group.
Overall, progression-free survival (time from treatment until the cancer progresses) was 4.5 months in the HIA group compared to 3.7 months in the IV group and was 24% compared to 8% after 1 year, in favor of HIA. First progression in the liver was seen in 54.8% of HIA patients compared to 89.4% of IV patients.
Side-effects to treatment were more severe in the IV group. Low blood cell count occurred in 42.1% of IV patients compared to 21.2% of HIA patients and low immune cell count occurred in 62.6% of IV patients and 28.7% of HIA patients. HIA patients mainly experienced catheter complications (related to the insertion of a thin flexible tube) and liver toxicity.
The bottom line
The authors concluded that HIA treatment did not improve overall survival in patients when compared to IV treatment with fotemustine despite better response rates and progression-free survival.
The fine print
Biological factors such as cancer mutations may have biased the results.
What’s next?
If you are considering chemotherapy as a treatment option please consult your doctor for potential benefits and risks involved.
Published By :
Annals of oncology
Date :
Feb 07, 2014
