Angioocclusive chemotherapy in melanoma: rationale and technical considerations

To date, systemic chemotherapy for melanoma metastases appears to be of only limited benefit since tumoricidal drug concentrations can hardly overcome primary or secondary drug resistance of melanoma cells. Recently, intraarterial infusion techniques with or without regional venous drug hemofiltration have been shown to provide high cytotoxic levels at the target region, thus subsequently using persistent (chemo-embolization) or transient (microspheres, liposomes) blocking techniques may optimize the pharmacological advantage of regional drug delivery. In a pilot series in metastatic liver cancer a significant increase of drug concentration within the target tissue could be achieved while systemic levels were found to be reduced during angio-occlusion. The rationale of angio-occlusive approaches in melanoma offers the possibility of focusing the anti-tumor action directly at the target so that improved response rates can be expected.