A comparison of isolated limb infusion/perfusion, immune checkpoint inhibitors, and intralesional therapy as first‐line treatment for patients with melanoma in‐transit metastases
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Isolated limb infusion and perfusion (ILI/ILP) has been a mainstay treatment for unresectable melanoma in-transit metastases (ITM), but increased use of immune checkpoint inhibitors (ICI) and intralesional therapy (talimogene laherparepvec [TVEC]) introduced several different management options. This study compares first-line ILI/ILP, ICI, and TVEC. METHODS: Retrospective review from 12 international institutions included patients treated from 1990 to 2022 with first-line ILI/ILP, ICI, or TVEC for unresectable melanoma ITM. RESULTS: A total of 551 patients were treated, with ILI/ILP (n = 356), ICI (n = 125), and TVEC (n = 70) with median follow-up of 5.5 years. Tumor burden was highest with ILI/ILP and lowest with TVEC (p = .002). Breslow thickness was lowest with TVEC (p = .007). TVEC was mostly used in stage IIIB disease versus IIIC for ILI/ILP and ICI (p = .01). Using ICI as the reference category, TVEC had the highest odds of a complete response (CR) (odds ratio, 1.96; p = .029) and a longer local progression-free survival (PFS) (hazard ratio [HR], 0.40; p = .003). ILI/ILP had shorter local PFS (HR, 1.72; p = .012), PFS (HR, 1.79; p < .001), distant metastasis-free survival (DMFS) (HR, 1.75; p = .014), overall survival (HR, 1.82; p = .009), and melanoma-specific survival (HR, 2.29; p = .004). Stage IIIB disease had longer DMFS (HR, 0.24; p < .001) compared to IIIC/D. CONCLUSIONS: TVEC as first-line therapy for unresectable melanoma ITM was associated with superior CR rates and local PFS. Notably, TVEC was used in patients with a lower Breslow thickness, disease stage, and tumor burden. Therefore, when compared to ILI/ILP and ICI, TVEC should be considered as first-line therapy for unresectable stage IIIB melanoma ITM with minimal tumor burden and lower Breslow thickness.
Source: Cancer
DOI: 10.1002/cncr.35636
Authors: Danielle K. DePalo, Michelle M. Dugan, Syeda Mahrukh Hussnain Naqvi, David W. Ollila, Tina J. Hieken, Matthew S. Block, Winan J. van Houdt, Michel W. J. M. Wouters, Sophie J. M. Reijers, Nethanel Asher, Kristy K. Broman, Zoey Duncan, Matilda Anderson, David E. Gyorki, Hayden Snow, Jenny Held, Jeffrey M. Farma, John T. Vetto, Jane Y. C. Hui, Madison Kolbow, Robyn P. M. Saw, Serigne N. Lo, Georgina V. Long, John F. Thompson, Youngchul Kim, Lilit Karapetyan, Lars Ny, Alexander C. J. van Akkooi, Roger Olofsson Bagge, Jonathan S. Zager
Institutions: Moffitt Cancer Center, University of North Carolina at Chapel Hill, Mayo Clinic, Mayo Clinic Comprehensive Cancer Center (Minnesota), The Netherlands Cancer Institute, Rabin Medical Center, United States Department of Veterans Affairs, University of Alabama at Birmingham, Birmingham VA Medical Center, The University of Melbourne, Peter MacCallum Cancer Centre, Fox Chase Cancer Center, Oregon Health & Science University, University of Minnesota, The University of Sydney, Royal North Shore Hospital, Melanoma Institute Australia, Royal Prince Alfred Hospital, Sahlgrenska University Hospital, University of Gothenburg
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Conquer Cancer Foundation, Amgen, Bristol-Myers Squibb, Pfizer, AstraZeneca, GlaxoSmithKline, Sanofi, Array BioPharma, Regeneron Pharmaceuticals, Les Laboratories Pierre Fabre, Innovent Biologics, Syndax Pharmaceuticals, SkylineDx, OncoSec Medical, British Association of Dermatologists, Bayer HealthCare, Qbiotics, NeraCare, Genentech, Novartis Pharma, Sanofi Genzyme, Pharmacyclics, Sanofi Pasteur, Medical Research Council, National Health and Medical Research Council, National Cancer Institute
OpenAlex ID: W4404210451