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Updated: Oct 29, 2025
Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma
Published on: January 25, 2015
A Prospective Study of Intraarterial Infusion Chemotherapy in Advanced Wild-Type BRAF Melanoma Patients
Stefano Guadagni1, Odysseas Zoras2, Giammaria Fiorentini3
1Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
Background:
Treatment strategies for advanced cutaneous melanoma (CM) patients, resistant or not treatable with novel target and immunotherapeutic drugs, remain a significant challenge, particularly for patients with unresectable stage IIIC/D disease localized to inferior limbs and pelvis, for whom specific outcomes are rarely considered.
Materials And Methods:
This is a prospective study of multidisciplinary treatments, including locoregional melphalan chemotherapy, in 62 BRAF wild-type CM patients with locoregional metastases in the inferior limbs and pelvis, including inguinal regions. Patients were either in progression following or ineligible for, or not treatable with novel immunotherapy. For exclusively inferior limb-localised disease, patients received locoregional melphalan chemotherapy performed by hyperthermic isolated limb perfusion (n = 19) or isolated limb infusion (n = 19), and for synchronous lesions localised to inferior limbs and pelvis, received hypoxic pelvic and limb perfusion (n = 24). Additional multidisciplinary therapy included local, locoregional and systemic treatments and the primary endpoint was tumour response.
Results:
The objective response rate following first cycle of locoregional chemotherapy was 37.1% at 3 mo and median progression-free survival was 4-mo, with 12.9% procedure-related complications, 30.6% low-grade haematological toxicity and 11.3% severe limb toxic tissue reactions. Multivariate logistic regression showed that the odds of response were significantly higher for patients ≤ 75 y of age and for patients with locoregional metastases exclusively located in the inferior limbs.
Conclusion:
In this subgroup of CM patients with BRAF wild-type status, locoregional metastases localized to inferior limbs and pelvis, in progression following or ineligible for immunotherapy, melphalan locoregional chemotherapy demonstrated a safe and effective profile.
Trial Registration:
ClinicalTrials.gov Identifier NCT01920516; date of trial registration: August 6, 2013.
Insights
Locoregional melphalan chemotherapy offers a safe and effective treatment for advanced cutaneous melanoma (CM) patients with unresectable limb and pelvic metastases, especially when immunotherapy is not an option. This approach showed a 37.1% objective response rate in a prospective study.
Area of Science:
- Oncology
- Medical treatment
- Clinical research
Background:
- Advanced cutaneous melanoma (CM) presents treatment challenges, particularly for unresectable stage IIIC/D disease in the limbs and pelvis.
- Patients resistant or ineligible for novel targeted and immunotherapies require alternative treatment strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of multidisciplinary treatments, including locoregional melphalan chemotherapy, for advanced CM with unresectable metastases in the inferior limbs and pelvis.
- To assess tumor response in BRAF wild-type CM patients progressing after or ineligible for immunotherapy.
Main Methods:
- A prospective study involving 62 BRAF wild-type CM patients with locoregional metastases in the inferior limbs and pelvis.
- Treatments included hyperthermic isolated limb perfusion, isolated limb infusion, or hypoxic pelvic and limb perfusion with melphalan chemotherapy.
- Multidisciplinary therapy incorporated local, locoregional, and systemic treatments.
Main Results:
- An objective response rate of 37.1% was observed at 3 months post-locoregional chemotherapy.
- Median progression-free survival was 4 months.
- Procedure-related complications were 12.9%, with 30.6% low-grade hematological toxicity and 11.3% severe limb tissue reactions.
Conclusions:
- Locoregional melphalan chemotherapy demonstrated a safe and effective profile in this subgroup of advanced CM patients.
- Younger patients (≤ 75 years) and those with exclusively limb-localized metastases showed significantly higher odds of response.
