ORLANDO – The type of regional chemotherapy given to patients with in-transit or intralymphatic melanoma of the extremities appears to make a difference in out-of-field recurrences and time to distant recurrence, reported investigators at a symposium of the Society of Surgical Oncology.
A study of 214 patients who underwent either first-time hyperthermic isolated limb perfusion (HILP) or isolated limb infusion (ILI) for in-transit melanomas showed that HILP was associated with significantly more in-field complete responses (P = .01), and a longer median time to out-of-field recurrences, compared with ILI, said Dr. Ketan Sharma of Duke University Medical Center in Durham, NC.
Dr. Ketan Sharma
"We found that perfusion complete response and infusion complete response exhibit similar degrees of in-field disease control," Dr. Sharma said.
However, "recurrent disease after a regional therapy complete response is complex, and requires a multidisciplinary approach to treatment," he added.
The National Cancer Institute defines an in-transit metastasis as a "type of metastasis in which skin cancer spreads through a lymph vessel and begins to grow more than 2 centimeters away from the primary tumor but before it reaches the nearest lymph node."
The investigators used data from a prospective database of patients with in-transit melanomas to take a retrospective look at complete responders to either of the two isolated limb therapies. They compared patterns of recurrence and effects on outcomes between the two modalities. In all, 81 patients had first-time HILP and 133 had first-time ILI.
Among 36 patients with a complete response to HILP, 24 had recurrences. Of these patients, 11 experienced in-field-only recurrences, 12 had out-of-field-only recurrences, and 1 patient had a mixed recurrence pattern.
In comparison, 28 of 37 patients with complete responses to ILI had recurrences (9 had in-field-only, 16 had out-of-field, and 3 had mixed recurrence patterns).
There were no significant differences between the perfusion or infusion therapies in time to in-field recurrence, but time to out-of-field recurrence to regional nodes was significantly longer with HILP (42 months vs. 14 months; P = .02). When the authors looked at distant out-of-field recurrences, however, the difference between the treatment types was not significant.
Overall survival after all procedures (including partial responses, stable disease, and nonresponses) was also similar among the treatment types. The overall survival rate after a complete response was higher with HILP (77% vs. 54%); the investigators described this as clinically significant, although it was not statistically significant (P = .1).
At last follow-up (median, 4.0 years for HILP and 2.5 years for ILI), 12 patients who had a complete response to HILP were alive without recurrence for a median duration of 6.5 years, and 24 had recurrences at a median of 3.3 years after perfusion therapy and received additional therapy. Among the latter group, 2 had no evidence of disease, 9 were alive with disease, and 13 died, at a median of 3.1 years.
Among the complete responders to ILI, 9 had no recurrence at a median of 2.6 years; 28 had recurrences at a median of 2.3 years, and received additional treatment. At last follow-up, 8 of the 28 had no evidence of disease (median, 3.9 years), 7 were alive with disease (median, 1.2 years), and 13 had died (median, 2.1 years).
The investigators concluded that the higher proportion of recurrences among patients with an initial complete response to ILI may be due to more frequent lymph node recurrences (nine vs. one in patients who had a complete response to HILP).
The study was supported by Roche/Schering-Plough. Dr. Sharma had no disclosures.