Regional perfusion with cis-platinum and dacarbazine

Area of Science:

• Oncology
• Surgical Oncology
• Pharmacology

Background:

• Malignant melanoma, particularly locally metastatic disease, presents treatment challenges.
• Isolated extremity perfusion (IEP) is a regional chemotherapy technique.
• Evaluating novel chemotherapeutic agents for advanced melanoma is critical.

Purpose of the Study:

• To evaluate the efficacy and safety of isolated extremity perfusion with cis-platinum compared to DTIC for malignant melanoma.
• To assess disease-free survival rates in different stages of melanoma following treatment.

Main Methods:

• Twenty-two patients with malignant melanoma underwent isolated extremity perfusion with cis-platinum.
• Eighteen patients had local metastatic disease (M. D. Anderson stages II and III A, B, AB), and four were stage I.
• Five additional patients received isolated DTIC (dacarbazine) perfusion.

Main Results:

• DTIC perfusion resulted in tumor regression rates of 30%-80% but was followed by recurrences within 4 months.
• Cis-platinum perfusion in stage-III AB cases showed a tendency for tumor recurrence within 4 months.
• Stage-III A and stage-II cis-platinum perfused cases achieved disease-free survival of 17 and 20 months, respectively.
• Maintaining cis-platinum perfusion temperature below 40°C is essential to avoid neural damage, unlike DTIC perfusion where temperatures can range between 40°C and 41°C.

Conclusions:

• Isolated extremity perfusion with cis-platinum demonstrates superior long-term efficacy for stage II and III A malignant melanoma compared to DTIC.
• Strict temperature control during cis-platinum perfusion is vital to mitigate the risk of neurotoxicity.
• IEP with cis-platinum represents a viable treatment option for select patients with advanced localized melanoma.