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Arulananda S, Parakh S, Palmer J, Goodwin M, Andrews MC, Cebon J. A pilot study of intrahepatic yttrium-90 microsphere radioembolization in combination with intravenous cisplatin for uveal melanoma liver-only metastases. Cancer Rep (Hoboken) 2020; 2:e1183. [PMID: 32721131 DOI: 10.1002/cnr2.1183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Metastatic uveal melanoma is a highly aggressive disease with no standard of care treatment option. A large proportion of patients have liver-only metastatic disease which raises the question if liver-directed therapy can be efficacious in this subpopulation. AIMS The study aims to evaluate the safety and efficacy of radiosensitizing chemotherapy in combination with yttrium-90 microspheres in patients with uveal melanoma with liver-only metastases. METHODS AND RESULTS This single arm, open labeled, non-randomized study enrolled 10 patients with liver-only metastatic uveal melanoma between November 2012 and January 2018. Eligible patients received intrahepatic yttrium-90 microspheres followed by intravenous cisplatin (20 mg/m2) for 5 days. Ten patients were enrolled, but nine patients received treatment who were included in the final analysis with a median follow-up of 30 months (range 7 to 44). Five (50%) were female, five (50%) had an elevated lactate dehydrogenase (LDH), and one (10%) had prior anti-PD-1 therapy. The combination was well tolerated with no greater than or equal to grade 3 toxicity observed. The liver objective response rate (ORR) was 33% (3/9), the median progression-free survival (PFS) in the liver was 3 months (95% CI, 3-NA), and the extrahepatic PFS was 3 months (95% CI, 3-NA). Seventy-eight percent (7/9) received an immune checkpoint inhibitor on disease progression, with no responses seen. The median overall survival (OS) was 10 months (95% CI, 7-NA). CONCLUSION The combination of cisplatin with yttrium-90 microspheres was well tolerated; however, it was associated with intrahepatic disease control of relatively short duration. No responses were seen in patients treated with immune checkpoint inhibitors post radioembolization.
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Affiliation(s)
- Surein Arulananda
- Medical Oncology Unit, Austin Health, Heidelberg, Victoria, Australia.,Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
| | - Sagun Parakh
- Medical Oncology Unit, Austin Health, Heidelberg, Victoria, Australia.,Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
| | - Jodie Palmer
- Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Mark Goodwin
- Department of Radiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Miles C Andrews
- Medical Oncology Unit, Austin Health, Heidelberg, Victoria, Australia.,Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Cebon
- Medical Oncology Unit, Austin Health, Heidelberg, Victoria, Australia.,Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
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Lodh S, Maher R, Guminski A. Intra-arterial infusion and chemo-embolization for melanoma liver metastases. J Surg Oncol 2014; 109:376-82. [PMID: 24500702 DOI: 10.1002/jso.23551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/16/2013] [Indexed: 12/31/2022]
Abstract
This article will review the rationale for hepatic arterial administration of agents to treat melanoma liver metastases, the techniques and practical considerations pertinent to hepatic arterial therapy, the variety of agents that have been used and the reported outcomes. Recent and emerging developments will be highlighted and the potential role of liver-directed therapies in the context of molecular advances and improved systemic therapy will be discussed.
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Affiliation(s)
- Suhrid Lodh
- Department of Radiology, Royal North Shore Hospital, St Leonards, Australia
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