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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2020

01-12-2020 | Melanoma | Melanoma

Oncologic Outcomes After Isolated Limb Infusion for Advanced Melanoma: An International Comparison of the Procedure and Outcomes Between the United States and Australia

Authors: Michael J. Carr, MD, MS, James Sun, MD, Hidde M. Kroon, MD, PhD, John T. Miura, MD, Georgia M. Beasley, MD, MHS, Norma E. Farrow, MD, Paul J. Mosca, MD, Michael C. Lowe, MD, MA, Clara R. Farley, MD, Youngchul Kim, PhD, Syeda Mahrukh Hussnain Naqvi, MD, MPH, Dennis A. Kirichenko, MS, Aishwarya Potdar, MS, Hala Daou, BS, Dean Mullen, MD, Jeffrey M. Farma, MD, Michael A. Henderson, MBBS, BMedSc, David Speakman, MBBS, Jonathan Serpell, MBBS, MEd, Keith A. Delman, MD, B. Mark Smithers, MBBS, Brendon J. Coventry, MBBS, PhD, Douglas S. Tyler, MD, John F. Thompson, MD, Jonathan S. Zager, MD

Published in: Annals of Surgical Oncology | Issue 13/2020

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Abstract

Background

Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose chemotherapy to extremities affected by locally advanced or in-transit melanoma. This study compared the outcomes of melanoma patients treated with ILI in the United States of America (USA) and Australia (AUS).

Methods

Patients with locally recurrent in-transit melanoma treated with ILI at USA or AUS centers between 1992 and 2018 were identified. Demographic and clinicopathologic characteristics were collected. Primary outcomes of treatment response, in-field progression-free survival (IPFS), distant progression-free survival (DPFS), and overall survival (OS) were evaluated by the Kaplan-Meier method. Multivariable analysis evaluated whether availability of new systemic therapies affected outcomes.

Results

More ILIs were performed in AUS (n = 411, 60 %) than in the USA (n = 276, 40 %). In AUS, more ILIs were performed for stage 3B disease than in the USA (62 % vs 46 %; p < 0.001). The reported complete response rates were similar (AUS 30 % vs USA 29 %). Among the stage 3B patients, AUS patients had better IPFS (p = 0.001), whereas DPFS and OS were similar between the two countries. Among the stage 3C patients, the USA patients had better OS (p < 0.001), whereas IPFS and DPFS were similar. Availability of new systemic therapies did not affect IPFS or DPFS in either country. However, the USA patients who received ILI after ipilimumab approval in 2011 had significantly improved OS (hazard ratio, 0.62; p = 0.013).

Conclusions

AUS patients were treated at an earlier disease stage than the USA patients with better IPFS for stage 3B disease. The USA patients treated after the availability of new systemic therapies had a better OS.
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Metadata
Title
Oncologic Outcomes After Isolated Limb Infusion for Advanced Melanoma: An International Comparison of the Procedure and Outcomes Between the United States and Australia
Authors
Michael J. Carr, MD, MS
James Sun, MD
Hidde M. Kroon, MD, PhD
John T. Miura, MD
Georgia M. Beasley, MD, MHS
Norma E. Farrow, MD
Paul J. Mosca, MD
Michael C. Lowe, MD, MA
Clara R. Farley, MD
Youngchul Kim, PhD
Syeda Mahrukh Hussnain Naqvi, MD, MPH
Dennis A. Kirichenko, MS
Aishwarya Potdar, MS
Hala Daou, BS
Dean Mullen, MD
Jeffrey M. Farma, MD
Michael A. Henderson, MBBS, BMedSc
David Speakman, MBBS
Jonathan Serpell, MBBS, MEd
Keith A. Delman, MD
B. Mark Smithers, MBBS
Brendon J. Coventry, MBBS, PhD
Douglas S. Tyler, MD
John F. Thompson, MD
Jonathan S. Zager, MD
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09051-y

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