N. E. Farrow1, C. J. Puza3, D. S. Tyler2, G. M. Beasley1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA 2University Of Texas Medical Branch,Department Of Surgery,Galveston, TX, USA 3Duke University Medical Center,School Of Medicine,Durham, NC, USA
Introduction:
Isolated limb infusion (ILI) is an effective treatment for recurrent, unresectable extremity melanoma, with about 30% of patients experiencing a complete response after therapy. Recent introduction of multiple novel therapies for advanced melanoma has led to decreased utilization of ILI. Here we report long-term ILI outcomes from a single institution.
Methods:
Our prospective institutional database was used to identify all patients undergoing ILI with melphalan plus dactinomycin between 2003 and 2013. Data pertaining to tumor characteristics, procedure details of ILI, response at three months, date of in- and out-of-field progression and mortality were collected.
Results:
There were 167 ILI procedures performed on a total of 131 patients. For the 131 first-time ILI procedures, 38 patients (29%) had a complete response (CR), 17 (13%) had a partial response (PR), 19 (15%) had stable disease (SD), and 51 (39%) had progressive disease (PD) at three months. Six patients were lost to follow up. Overall survival was significantly improved in patients who experienced a CR compared to partial- or non-responders (PR, SD, PD), (P-value < 0.001). Overall 5-year survival was 62.8% for the CR group vs 28.8% for non-responders. Among CRs, 15/38 (39%) required no additional therapy and remained free of disease at median 3.9-year follow-up. Of all 131 patients, 79 patients (60%) developed progressive disease outside of the affected extremity, with an average time to out-of-field progression of 8.5 months (range 25 days to 4.4 years). Of all 131 patients, 33 (25%) went on to have repeat ILI, and 33 (25%) went on to targeted therapy or checkpoint inhibitors after ILI.
Conclusion:
Patients with a CR to ILI can have prolonged survival with ILI alone. Many patients with regional disease go on to develop systemic disease despite ILI and will require effective systemic therapy for disease control. With multiple new therapies now being applied to patients with recurrent unresectable cutaneous melanoma, ILI can still be considered after systemic treatment failures, for patients who have persistent extremity recurrences without systemic progression, and in combination with systemic therapy.
