Transarterial chemoembolization of liver metastases from uveal melanoma after failure of systemic therapy: toxicity and outcome.

Abstract

The liver is the predominant site of metastases in the majority of patients with uveal melanoma, suggesting the evaluation of regional treatment approaches. Here we report our experience with transarterial chemoembolization (TACE) in uveal melanoma patients with pretreated liver metastases. Twenty-five patients were treated with fotemustine-based or cisplatin-based TACE after treatment failure of systemic therapy between 2003 and 2008 at our institution. Grade III toxicity consisted of gastric ulcer (n=1), fever (n=3), splenic infarction (n=1), and thrombocytopenia (n=1). No grade IV toxicity or catheter-associated complications were observed. Fourteen of 25 patients (56%) had stable disease for at least 2 months and four had partial remission. The median progression-free survival (PFS) was 3 months (95% confidence interval: 2-4 months) and the median overall survival (OS) was 6 months (95% confidence interval: 5-7 months), with 15% of patients alive at 1 year. Both PFS and OS were significantly longer, when pretreatment lactate dehydrogenase was below the two-fold upper limit of normal (n=11): PFS 5 versus 2 months (P<0.001) and OS 11 versus 5 months (P=0.012). All patients with lactate dehydrogenase less than 2xupper limit of normal had a clinically detectable benefit. TACE is well tolerated and effective in pretreated patients with liver metastases from uveal melanoma. TACE should further be evaluated as first-line therapy in prospective randomized clinical trials.

• Authors: Ronny Schuster, Marita Lindner, Frank Wacker, Maren Krössin, Nikolaos Bechrakis, Michael H Foerster, Eckhard Thiel, Ulrich Keilholz, Alexander Schmittel
• Journal: Melanoma research (Melanoma Res) Vol. 20 Issue 3 Pg. 191-6 (Jun 2010) ISSN: 1473-5636 [Electronic] England
• PMID: 20335820 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Nitrosourea Compounds
• Organophosphorus Compounds
• fotemustine
• Cisplatin

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (therapeutic use)
• Chemoembolization, Therapeutic (methods)
• Cisplatin (therapeutic use)
• Disease-Free Survival
• Female
• Humans
• Liver Neoplasms (secondary, therapy)
• Male
• Melanoma (drug therapy, pathology, therapy)
• Middle Aged
• Nitrosourea Compounds (therapeutic use)
• Organophosphorus Compounds (therapeutic use)
• Randomized Controlled Trials as Topic
• Remission Induction
• Treatment Outcome
• Uveal Neoplasms (drug therapy, pathology, therapy)