Melanoma with liver metastasis: a review on treatment options

The authors reviewed different treatment options available for melanoma patients with cancer spread to the liver.

In advanced melanoma (stages 3 and 4), cancer has spreads from the skin to other parts of the body. This is known as metastasis. Treatment of liver metastasis in advanced melanoma still remains a challenge. The progression of skin melanoma and eye melanoma follow distinctly different courses. Spreading of cancer to the liver is very common in eye melanoma. 89% of patients who develop metastases of eye melanoma have cancer spread to the liver. In contrast, only 10-20% of metastatic skin melanoma patients have cancer spread to the liver.

Understanding of the different treatment options available for melanoma that has spread to the liver will aid in improving the survival outcome of these patients.

The authors aimed to review different treatment options from the published clinical trials for skin and eye melanoma patients with cancer that has spread to the liver.

Surgery

6 studies were reviewed comparing the outcomes of patients undergoing surgery to those who did not. In eye melanoma, the average overall survival (patients who were still alive after treatment) was 14 to 24 months. This was compared to 3 to 12 months for those who did not undergo surgery. For skin melanoma the overall survival for patients undergoing surgery was 28 months. This was compared to 6 months for those who did not.

Immunotherapy

Immunotherapies are treatments that stimulate the immune system to respond to cancer cells in the same way it would normally fight a virus or bacteria. Examples of immunotherapies include vemurafenib (Keytruda), trametinib (Mekinist) and ipilimumab (Yervoy). All of these drugs have shown effectiveness in clinical trials and are approved for use in advanced skin melanoma.

A number of treatments have been tested in eye melanoma patients with cancer spread to liver but few have shown promising results. The average overall survival from these studies was 6 to 14 months. Ipilimumab, however, is currently undergoing further trials in advanced eye melanoma.

Regional treatments

Regional treatments are applied directly to the liver. There are several different types of regional treatments, such as hepatic intra-arterial infusion (HIA) and isolated hepatic perfusion (IHP), among others.

In HIA, chemotherapy is delivered directly to the artery of the liver through a catheter (tube). In one study, HIA of the chemotherapy fotemustine (Muphoran) was compared with intravenous (IV, injection into a vein) delivery in eye melanoma patients. The overall response rate (response to treatment, such as tumor shrinkage) was 11% for HIA compared to 2% for IV administration of the drug. However, there was no significant difference in overall survival.

IHP is a surgical procedure in which blood circulation in the liver is cut off from the rest of the body. Then high concentrations of chemotherapy drugs are circulated through the liver. Based on 3 studies in patients with advanced eye melanoma, the tumor response rate was 33% to 62%. The average overall survival was 10 to 12 months. However, this procedure takes 7-8 hours to perform and is associated with many side effects.

The authors concluded that for skin melanoma with cancer spread to liver, systemic therapy is the best treatment option. For eye melanoma with liver metastasis, regional therapy holds promise.