In a nutshell
The authors evaluated the effect of percutaneous hepatic perfusion (PHP, a method of treating melanoma that has spread to the liver) with melphalan (Alkeran). This study found that PHP with melphalan improved outcomes in melanoma patients with cancer spread to the liver.
Some background
In advanced melanoma (stage 3/4), cancer spreads to other parts of the body (metastasis). Progression of skin melanoma and eye melanoma follow distinctly different courses. For example, 50% of patients who develop metastasis in eye melanoma have cancer spread to the liver. In contrast, only 3-5% of metastatic skin melanoma patients have cancer spread to the liver in isolation.
Treatment of liver metastasis in advanced melanoma still remains a challenge. Melphalan has long been established as an effective therapy for melanoma spread to the liver. In PHP, high concentrations of chemotherapy drugs are administered into the liver by separating the blood circulation in the liver from the rest of the body. In this way the chemotherapy is not circulated throughout the body.
Comparison of effectiveness of PHP with standard therapy is needed to understand the benefits of PHP in advanced melanoma with liver metastasis.
Methods & findings
The authors aimed to compare two different treatment strategies: PHP with melphalan and the standard chemotherapy.
93 patients with eye or skin melanoma with liver metastases were randomly assigned to one of two groups. In group 1, 44 patients received PHP with melphalan (PHP-mel). In group 2, 49 patients received the best alternative care, including chemotherapy or supportive care. The PHP-mel was repeatable every 4–8 weeks.
The hepatic progression-free survival (time following treatment before the disease progressed in the liver) was 7 months for group 1 and 1.6 months for group 2. An objective response to treatment (such as tumor shrinkage) was seen in 36.4% of group 1 and 2% of group 2. The overall progression-free survival was 5.4 months for group 1 patients and 1.6 months for group 2. The average overall survival (time from treatment until death from any cause) was similar for both the groups, at 10.6 months for group 1 and 10 months for group 2.
The main treatment-related adverse event was bone-marrow suppression (decrease in immune cells). 4 patients died due to treatment-related adverse events in group 1.
The bottom line
The authors concluded that melanoma patients treated with PHP-mel had better outcomes compared to patients treated with standard care.
Published By :
Annals of Surgical Oncology
Date :
Nov 23, 2015
