Isolated limb perfusion can successfully treat in-transit melanoma

The authors aimed to determine the differences between melphalan or TNF- melphalan isolated limb perfusion in treating melanoma that has spread from the original site.

In melanoma patients in-transit metastases can occur, indicating that the cancer has spread from the primary tumor site (site of first tumor) towards the lymph node (site that holds the immune cells in the body).

Isolated limb perfusion is a treatment option for in-transit metastases that isolates the blood flow to the diseased limb to allow for a more concentrated chemotherapy in the cancerous area without affecting other parts of the body. In some cases this can be carried out using melphalan (Alkeran – anti-cancer drug) or tumor necrosis factor α (TNF – protein involved in the immune response) – melphalan.

The aim of this study was to determine the differences between melphalan and TNF-melphalan chemotherapy in melanoma.

60 patients underwent isolated limb perfusion. From this, 19 patients (32%) were treated with melphalan and 41 patients (68%) were treated with TNF-melphalan. Toxicity was experienced by all patients receiving isolated limb perfusion.

The overall response rate (patients experiencing a decrease in tumor size) in patients treated with melphalan was 84% and patients treated with TNF-melphalan was 93%. Overall there 45% of patients experienced a complete response to treatment (disappearance of all cancer signs as a result of treatment), 45% of patients experienced a partial response (cancer responded to treatment but did not go away) and 5% of patients had no response to treatment (cancer was not affected by treatment). Complete response rates were 69% in those under 65 years of age compared to patients over 65 (29%).

Cancer return or progression occurred in 78% of patients 14 months after melphalan treatment and in 56% of patients 16 months after TNF-melphalan treatment. 63% of patients who experienced a complete response developed local recurrence (tumor growth at the primary tumor site) after 19 months. 63% of patients who experienced a partial response developed local recurrence after 14 months.

Systemic disease (affects a number of organs and tissues) occurred in 55% of patients after 40 months regardless of chemotherapy received. 74% of melphalan patients and 34% of TNF-melphalan patients died from melanoma. The 1-year melanoma-specific survival (patients who did not die from melanoma following treatment) rate after treatment was 89%. The 3-year survival rate was 65% and 5-year survival ratewas 39%. The average survival time following melphalan treatment was 51 months and following TNF- melphalan was 68 months.

The authors concluded that both melphalan and TNF-melphalan are successful treatments for melanoma.

There is limited clinical data available on melphalan and TNF-melphalan as melanoma treatment options.

If you are considering isolated limb perfusion using melphalan or TNF- melphalan and have concerns about potential side-effects, please consult your doctor.