Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma

An International Multicenter Analysis

John T. Miura, Hidde M. Kroon, Georgia M. Beasley, Dean Mullen, Norma E. Farrow, Paul J. Mosca, Michael C. Lowe, Clara R. Farley, Youngchul Kim, Syeda Mahrukh Hussnain Naqvi, Aishwarya Potdar, Hala Daou, James Sun, Jeffrey M. Farma, Michael A. Henderson, David Speakman, Jonathan Serpell, Keith A. Delman, B. Mark Smithers, Brendon J. Coventry & 3 others Douglas Tyler, John F. Thompson, Jonathan S. Zager

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose regional chemotherapy to patients with locally advanced or in-transit melanoma located on a limb. The current international multicenter study evaluated the perioperative and long-term oncologic outcomes for patients who underwent ILI for stage 3B or 3C melanoma. Methods: Patients undergoing a first-time ILI for stage 3B or 3C melanoma (American Joint Committee on Cancer [AJCC] 7th ed) between 1992 and 2018 at five Australian and four United States of America (USA) tertiary referral centers were identified. The primary outcome measures included treatment response, in-field (IPFS) and distant progression-free survival (DPFS), and overall survival (OS). Results: A total of 687 first-time ILIs were performed (stage 3B: n = 383, 56%; stage 3C; n = 304, 44%). Significant limb toxicity (Wieberdink grade 4) developed in 27 patients (3.9%). No amputations (grade 5) were performed. The overall response rate was 64.1% (complete response [CR], 28.9%; partial response [PR], 35.2%). Stable disease (SD) occurred in 14.5% and progressive disease (PD) in 19.8% of the patients. The median follow-up period was 47 months, with a median OS of 38.2 months. When stratified by response, the patients with a CR or PR had a significantly longer median IPFS (21.9 vs 3.0 months; p < 0.0001), DPFS (53.6 vs 12.7 months; p < 0.0001), and OS (46.5 vs 24.4 months; p < 0.0001) than the nonresponders (SD + PD). Conclusion: This study is the largest to date reporting long-term outcomes of ILI for locoregionally metastatic melanoma. The findings demonstrate that ILI is effective and safe for patients with stage 3B or 3C melanoma confined to a limb. A favorable response to ILI is associated with significantly longer IFPS, DPFS, and OS.

Original languageEnglish (US)
JournalAnnals of surgical oncology
DOIs
StatePublished - Jan 1 2019

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Melanoma
Extremities
Disease-Free Survival
Survival
Amputation
Tertiary Care Centers
Multicenter Studies
Outcome Assessment (Health Care)
Drug Therapy
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma : An International Multicenter Analysis. / Miura, John T.; Kroon, Hidde M.; Beasley, Georgia M.; Mullen, Dean; Farrow, Norma E.; Mosca, Paul J.; Lowe, Michael C.; Farley, Clara R.; Kim, Youngchul; Naqvi, Syeda Mahrukh Hussnain; Potdar, Aishwarya; Daou, Hala; Sun, James; Farma, Jeffrey M.; Henderson, Michael A.; Speakman, David; Serpell, Jonathan; Delman, Keith A.; Mark Smithers, B.; Coventry, Brendon J.; Tyler, Douglas; Thompson, John F.; Zager, Jonathan S.

In: Annals of surgical oncology, 01.01.2019.

Research output: Contribution to journalArticle

Miura, JT, Kroon, HM, Beasley, GM, Mullen, D, Farrow, NE, Mosca, PJ, Lowe, MC, Farley, CR, Kim, Y, Naqvi, SMH, Potdar, A, Daou, H, Sun, J, Farma, JM, Henderson, MA, Speakman, D, Serpell, J, Delman, KA, Mark Smithers, B, Coventry, BJ, Tyler, D, Thompson, JF & Zager, JS 2019, 'Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma: An International Multicenter Analysis', Annals of surgical oncology. https://doi.org/10.1245/s10434-019-07288-w
Miura, John T. ; Kroon, Hidde M. ; Beasley, Georgia M. ; Mullen, Dean ; Farrow, Norma E. ; Mosca, Paul J. ; Lowe, Michael C. ; Farley, Clara R. ; Kim, Youngchul ; Naqvi, Syeda Mahrukh Hussnain ; Potdar, Aishwarya ; Daou, Hala ; Sun, James ; Farma, Jeffrey M. ; Henderson, Michael A. ; Speakman, David ; Serpell, Jonathan ; Delman, Keith A. ; Mark Smithers, B. ; Coventry, Brendon J. ; Tyler, Douglas ; Thompson, John F. ; Zager, Jonathan S. / Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma : An International Multicenter Analysis. In: Annals of surgical oncology. 2019.
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title = "Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma: An International Multicenter Analysis",
abstract = "Background: Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose regional chemotherapy to patients with locally advanced or in-transit melanoma located on a limb. The current international multicenter study evaluated the perioperative and long-term oncologic outcomes for patients who underwent ILI for stage 3B or 3C melanoma. Methods: Patients undergoing a first-time ILI for stage 3B or 3C melanoma (American Joint Committee on Cancer [AJCC] 7th ed) between 1992 and 2018 at five Australian and four United States of America (USA) tertiary referral centers were identified. The primary outcome measures included treatment response, in-field (IPFS) and distant progression-free survival (DPFS), and overall survival (OS). Results: A total of 687 first-time ILIs were performed (stage 3B: n = 383, 56{\%}; stage 3C; n = 304, 44{\%}). Significant limb toxicity (Wieberdink grade 4) developed in 27 patients (3.9{\%}). No amputations (grade 5) were performed. The overall response rate was 64.1{\%} (complete response [CR], 28.9{\%}; partial response [PR], 35.2{\%}). Stable disease (SD) occurred in 14.5{\%} and progressive disease (PD) in 19.8{\%} of the patients. The median follow-up period was 47 months, with a median OS of 38.2 months. When stratified by response, the patients with a CR or PR had a significantly longer median IPFS (21.9 vs 3.0 months; p < 0.0001), DPFS (53.6 vs 12.7 months; p < 0.0001), and OS (46.5 vs 24.4 months; p < 0.0001) than the nonresponders (SD + PD). Conclusion: This study is the largest to date reporting long-term outcomes of ILI for locoregionally metastatic melanoma. The findings demonstrate that ILI is effective and safe for patients with stage 3B or 3C melanoma confined to a limb. A favorable response to ILI is associated with significantly longer IFPS, DPFS, and OS.",
author = "Miura, {John T.} and Kroon, {Hidde M.} and Beasley, {Georgia M.} and Dean Mullen and Farrow, {Norma E.} and Mosca, {Paul J.} and Lowe, {Michael C.} and Farley, {Clara R.} and Youngchul Kim and Naqvi, {Syeda Mahrukh Hussnain} and Aishwarya Potdar and Hala Daou and James Sun and Farma, {Jeffrey M.} and Henderson, {Michael A.} and David Speakman and Jonathan Serpell and Delman, {Keith A.} and {Mark Smithers}, B. and Coventry, {Brendon J.} and Douglas Tyler and Thompson, {John F.} and Zager, {Jonathan S.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1245/s10434-019-07288-w",
language = "English (US)",
journal = "Annals of Surgical Oncology",
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TY - JOUR

T1 - Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma

T2 - An International Multicenter Analysis

AU - Miura, John T.

AU - Kroon, Hidde M.

AU - Beasley, Georgia M.

AU - Mullen, Dean

AU - Farrow, Norma E.

AU - Mosca, Paul J.

AU - Lowe, Michael C.

AU - Farley, Clara R.

AU - Kim, Youngchul

AU - Naqvi, Syeda Mahrukh Hussnain

AU - Potdar, Aishwarya

AU - Daou, Hala

AU - Sun, James

AU - Farma, Jeffrey M.

AU - Henderson, Michael A.

AU - Speakman, David

AU - Serpell, Jonathan

AU - Delman, Keith A.

AU - Mark Smithers, B.

AU - Coventry, Brendon J.

AU - Tyler, Douglas

AU - Thompson, John F.

AU - Zager, Jonathan S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose regional chemotherapy to patients with locally advanced or in-transit melanoma located on a limb. The current international multicenter study evaluated the perioperative and long-term oncologic outcomes for patients who underwent ILI for stage 3B or 3C melanoma. Methods: Patients undergoing a first-time ILI for stage 3B or 3C melanoma (American Joint Committee on Cancer [AJCC] 7th ed) between 1992 and 2018 at five Australian and four United States of America (USA) tertiary referral centers were identified. The primary outcome measures included treatment response, in-field (IPFS) and distant progression-free survival (DPFS), and overall survival (OS). Results: A total of 687 first-time ILIs were performed (stage 3B: n = 383, 56%; stage 3C; n = 304, 44%). Significant limb toxicity (Wieberdink grade 4) developed in 27 patients (3.9%). No amputations (grade 5) were performed. The overall response rate was 64.1% (complete response [CR], 28.9%; partial response [PR], 35.2%). Stable disease (SD) occurred in 14.5% and progressive disease (PD) in 19.8% of the patients. The median follow-up period was 47 months, with a median OS of 38.2 months. When stratified by response, the patients with a CR or PR had a significantly longer median IPFS (21.9 vs 3.0 months; p < 0.0001), DPFS (53.6 vs 12.7 months; p < 0.0001), and OS (46.5 vs 24.4 months; p < 0.0001) than the nonresponders (SD + PD). Conclusion: This study is the largest to date reporting long-term outcomes of ILI for locoregionally metastatic melanoma. The findings demonstrate that ILI is effective and safe for patients with stage 3B or 3C melanoma confined to a limb. A favorable response to ILI is associated with significantly longer IFPS, DPFS, and OS.

AB - Background: Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose regional chemotherapy to patients with locally advanced or in-transit melanoma located on a limb. The current international multicenter study evaluated the perioperative and long-term oncologic outcomes for patients who underwent ILI for stage 3B or 3C melanoma. Methods: Patients undergoing a first-time ILI for stage 3B or 3C melanoma (American Joint Committee on Cancer [AJCC] 7th ed) between 1992 and 2018 at five Australian and four United States of America (USA) tertiary referral centers were identified. The primary outcome measures included treatment response, in-field (IPFS) and distant progression-free survival (DPFS), and overall survival (OS). Results: A total of 687 first-time ILIs were performed (stage 3B: n = 383, 56%; stage 3C; n = 304, 44%). Significant limb toxicity (Wieberdink grade 4) developed in 27 patients (3.9%). No amputations (grade 5) were performed. The overall response rate was 64.1% (complete response [CR], 28.9%; partial response [PR], 35.2%). Stable disease (SD) occurred in 14.5% and progressive disease (PD) in 19.8% of the patients. The median follow-up period was 47 months, with a median OS of 38.2 months. When stratified by response, the patients with a CR or PR had a significantly longer median IPFS (21.9 vs 3.0 months; p < 0.0001), DPFS (53.6 vs 12.7 months; p < 0.0001), and OS (46.5 vs 24.4 months; p < 0.0001) than the nonresponders (SD + PD). Conclusion: This study is the largest to date reporting long-term outcomes of ILI for locoregionally metastatic melanoma. The findings demonstrate that ILI is effective and safe for patients with stage 3B or 3C melanoma confined to a limb. A favorable response to ILI is associated with significantly longer IFPS, DPFS, and OS.

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