ASO Author Reflections: Return to Isolated Limb Infusion for In-Transit Melanoma
- PDF / 191,453 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 56 Downloads / 161 Views
ASO AUTHOR REFLECTIONS
ASO Author Reflections: Return to Isolated Limb Infusion for InTransit Melanoma Michael J. Carr, MD, MS1, Hidde M. Kroon, MD, PhD2,3, and Jonathan S. Zager, MD1,4 Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL; 2Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia; 3Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; 4Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 1
PAST Since its introduction in the early 1990s, isolated limb infusion (ILI) has delivered high-dose chemotherapy to extremities harboring unresectable in-transit melanoma, without the associated morbidity of maximally invasive surgery in isolated limb perfusion or the toxicity of fully systemic treatments. Single- and multi-institutional large cohort series of ILI have demonstrated overall response (OR) rates of 59–84% and complete response (CR) rates of 26–38%.1,2 Moreover, a recent international multi-institutional effort demonstrated similar OR and CR rates. After a median follow-up of 47 months, median overall survival was 75 months for those who achieved a CR to ILI.3
variable significantly affected patient outcomes. Patients with earlier disease stage and lower burden of disease showed more favorable responses and outcomes. An increased OS in the US cohort was associated with the introduction of new systemic therapies. Surprisingly, the number of patients undergoing ILI decreased during the more recent years of the 26-year range of the study, notwithstanding a steady increase in the global incidence of melanoma. With the introduction of immunotherapy and targeted therapy over the past decade, this could reflect that patients have been guided toward these new systemic therapies despite a lack of robust clinical trial data supporting their use in unresectable in-transit melanoma. FUTURE
PRESENT 4
The present study sought to find a reason for the range of disease responses to ILI between Australia and the US, through evaluation of the differences in procedural protocol between high-volume institutions, with the aim of revealing factors that could lead to an improved and universally approved protocol. However, no single procedural
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09113-1) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 26 August 2020 Accepted: 26 August 2020 J. S. Zager, MD e-mail: [email protected]
In an oncologist’s armamentarium, ILI should continue to be included for the treatment of melanoma. ILI in unresectable in-transit limb melanoma results in higher response rates compared with immunotherapy and targeted therapy, without the associated systemic toxicity. As patients with low burden of disease benefit from ILI,5 and those who respond to ILI demonstrate a durable response, referral for ILI s
Data Loading...
