Efficacy and tolerability of chemosaturation in patients with hepatic metastases from uveal melanoma
Arne Estler, Christoph Artzner, Michael Bitzer, Konstantin Nikolaou, Rüdiger Hoffmann, Tobias Hepp, Florian Hagen, Thomas Eigentler, Andrea Forschner, Gerd Grözinger
Abstract
Background Patients with hepatic metastatic uveal melanoma still have a poor outcome. Purpose To evaluate overall survival (OS), progression-free survival (PFS), and response predictors in these patients treated with chemosaturation by percutaneous hepatic perfusion with melphalan (CS-PHP). Material and Methods Between June 2015 and March 2020, a total of 29 patients (median age 69.7 years; age range 30–81 years; 60% women; median BMI 25.7 kg/m 2 ; range 18.7–35.3kg/m 2 ; 1–6 procedures per patient) were treated with 53 CS-PHPs. All patients received cross-sectional imaging for initial and follow-up examinations. Baseline tumor load, extrahepatic tumor load, tumor response, PFS, and OS were assessed. Non-parametric statistics were used. Results After the initial CS-PHP, a partial response was observed in 11 patients (41%), stable disease in 12 patients (44%) and progressive disease in 4 patients (15%); two patients died before the response was evaluated. After initial CS-PHP, median OS was 12.9 ± 7.4 months and median PFS was 7.1 ± 7.4 months. OS after one year was 50%. After the second CS-PHP, median PFS was 7.9 ± 5.7 months. Seven patients had a liver tumor burden >25%, associated with a significantly shorter OS (6.0 ± 2.4 vs. 14.1 ± 12.7 months; P = 0.008). At the time of first CS-PHP, 41% (12/29) of the patients had extrahepatic metastases that did not affect OS (11.1 ± 8.4 months vs. 12.9 ± 13.6 months; P = 0.66). Conclusion CS-PHP is a safe and effective treatment for the hepatic metastatic uveal melanoma, especially for patients with a hepatic tumor burden <25%.