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Gonsalves CF. Immunoembolization for the Treatment of Uveal Melanoma Hepatic Metastases. Semin Intervent Radiol 2024; 41:20-26. [PMID: 38495266 PMCID: PMC10940043 DOI: 10.1055/s-0043-1777712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Uveal melanoma is the most common primary intraocular tumor in adults. Approximately 50% of patients develop metastatic disease despite successful treatment of the primary eye tumor. The liver is the most common site of metastatic disease occurring in more than 90% of patients. Clinical prognosis is dependent on the ability to control the growth of liver tumors. Locoregional therapies play an important role in stabilizing liver metastases, prolonging survival for patients with metastatic uveal melanoma. As overall survival is prolonged, the development of extrahepatic disease becomes more common. Immunoembolization, a form of liver-directed therapy, not only focuses on treating hepatic metastases by stimulating the local immune system to suppress the growth of liver tumors, but it potentially generates a systemic immune response delaying the growth of extrahepatic metastases as well. The following article discusses immunoembolization for the treatment of metastatic uveal melanoma including the rationale, mechanism of action, indications, contraindications, outcomes, and associated toxicities.
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Affiliation(s)
- Carin F. Gonsalves
- Interventional Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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2
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DePietro DM, Li X, Shamimi-Noori SM. Chemoembolization Beyond Hepatocellular Carcinoma: What Tumors Can We Treat and When? Semin Intervent Radiol 2024; 41:27-47. [PMID: 38495263 PMCID: PMC10940046 DOI: 10.1055/s-0043-1777716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Liver metastases are the most common malignancy found in the liver and are 20 to 40 times more common than primary hepatic tumors, including hepatocellular carcinoma. Patients with liver metastases often present with advanced disease and are not eligible for curative-intent surgery or ablative techniques. The unique hepatic arterial blood supply of liver metastases allows interventional radiologists to target these tumors with transarterial therapies. Transarterial chemoembolization (TACE) has been studied in the treatment of liver metastases originating from a variety of primary malignancies and has demonstrated benefits in terms of hepatic progression-free survival, overall survival, and symptomatic relief, among other benefits. Depending on the primary tumor from which they originate, liver metastases may have different indications for TACE, may utilize different TACE regimens and techniques, and may result in different post-procedural outcomes. This review offers an overview of TACE techniques and specific considerations in the treatment of liver metastases, provides an in-depth review of TACE in the treatment of liver metastases originating from colorectal cancer, neuroendocrine tumor, and uveal melanoma, which represent some of the many tumors beyond hepatocellular carcinoma that can be treated by TACE, and summarizes data regarding when one should consider TACE in their treatment algorithms.
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Affiliation(s)
- Daniel M. DePietro
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xin Li
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan M. Shamimi-Noori
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Khan SA, Almalki WH, Arora S, Kesharwani P. Recent approaches for the treatment of uveal melanoma: Opportunities and challenges. Crit Rev Oncol Hematol 2024; 193:104218. [PMID: 38040071 DOI: 10.1016/j.critrevonc.2023.104218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
Uveal melanoma (UM) is the most prevalent primary intraocular cancer in adult population. Primary methods for treatment of UM involves surgery Proton Beam Therapy (PBT), Plaque Brachytherapy, phototherapy, and Charged Particle Radiation Therapy (CPT). It has been found that approximately 50 % of patients diagnosed with UM ultimately experience development of metastatic disease. Furthermore, it has been identified that majority of the patient experience metastasis in liver with a prevalence of 95 %. Management of metastatic UM (MUM) involves various therapeutic modalities, including systemic chemotherapy, molecular targeted therapy, immunotherapy and liver directed interventions. We outline gene mutation in UM and addresses various treatment modalities, including molecular targeted therapy, miRNA-based therapy, and immunotherapy. Additionally, inclusion of ongoing clinical trials aimed at developing novel therapeutic options for management of UM are also mentioned.
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Affiliation(s)
- Sauban Ahmed Khan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Waleed H Almalki
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Swaranjeet Arora
- Department of Finance and Management, Lal Bahadur Shastri Institute of Management, 11/07 Dwarka Sector 11, Near Metro Station, New Delhi, Delhi 110075, India
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
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Tabotta F, Gnesin S, Dunet V, Ponti A, Digklia A, Boughdad S, Schaefer N, Prior JO, Villard N, Tsoumakidou G, Denys A, Duran R. 99mTc-macroaggregated albumin SPECT/CT predictive dosimetry and dose-response relationship in uveal melanoma liver metastases treated with first-line selective internal radiation therapy. Sci Rep 2023; 13:13118. [PMID: 37573346 PMCID: PMC10423257 DOI: 10.1038/s41598-023-39994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
First-line selective internal radiation therapy (SIRT) showed promising outcomes in patients with uveal melanoma liver metastases (UMLM). Patient survival depends on liver's disease control. SIRT planning is essential and little is known about dosimetry. We investigated whether 99mTc-MAA-SPECT/CT dosimetry could predict absorbed doses (AD) evaluated on 90Y-PET/CT and assess the dose-response relationship in UMLM patients treated with first-line SIRT. This IRB-approved, single-center, retrospective analysis (prospectively collected cohort) included 12 patients (median age 63y, range 43-82). Patients underwent MRI/CT, 18F-FDG-PET/CT before and 3-6 months post-SIRT, and 90Y-PET/CT immediately post-SIRT. Thirty-two target lesions were included. AD estimates in tumor and non-tumor liver were obtained from 99mTc-MAA-SPECT/CT and post-SIRT 90Y-PET/CT, and assessed with Lin's concordance correlation coefficients (ρc and Cb), Pearson's coefficient correlation (ρ), and Bland-Altman analyses (mean difference ± standard deviation; 95% limits-of-agreement (LOA)). Influence of tumor characteristics and microsphere type on AD was analyzed. Tumor response was assessed according to size-based, enhancement-based and metabolic response criteria. Mean target lesion AD was 349 Gy (range 46-1586 Gy). Concordance between 99mTc-MAA-SPECT/CT and 90Y-PET/CT tumor dosimetry improved upon dose correction for the recovery coefficient (RC) (ρ = 0.725, ρc = 0.703, Cb = 0.969) with good agreement (mean difference: - 4.93 ± 218.3 Gy, 95%LOA: - 432.8-422.9). Without RC correction, concordance was better for resin microspheres (ρ = 0.85, ρc = 0.998, Cb = 0.849) and agreement was very good between predictive 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (mean difference: - 4.05 ± 55.9 Gy; 95%LOA: - 113.7-105.6). After RC correction, 99mTc-MAA-SPECT/CT dosimetry overestimated AD (- 70.9 ± 158.9 Gy; 95%LOA: - 382.3-240.6). For glass microspheres, concordance markedly improved with RC correction (ρ = 0.790, ρc = 0.713, Cb = 0.903 vs without correction: ρ = 0.395, ρc = 0.244, Cb = 0.617) and 99mTc-MAA-SPECT/CT dosimetry underestimated AD (148.9 ± 267.5 Gy; 95%LOA: - 375.4-673.2). For non-tumor liver, concordance was good between 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (ρ = 0.942, ρc = 0.852, Cb = 0.904). 99mTc-MAA-SPECT/CT slightly overestimated liver AD for resin (3.4 ± 3.4 Gy) and glass (11.5 ± 13.9 Gy) microspheres. Tumor AD was not correlated with baseline or post-SIRT lesion characteristics and no dose-response threshold could be identified. 99mTc-MAA-SPECT/CT dosimetry provides good estimates of AD to tumor and non-tumor liver in UMLM patients treated with first-line SIRT.
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Affiliation(s)
- Flavian Tabotta
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Ponti
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Sajan A, Fordyce S, Sideris A, Liou C, Toor Z, Filtes J, Krishnasamy V, Ahmad N, Reis S, Brejt S, Baig A, Khan S, Caplan M, Sperling D, Weintraub J. Minimally Invasive Treatment Options for Hepatic Uveal Melanoma Metastases. Diagnostics (Basel) 2023; 13:diagnostics13111836. [PMID: 37296688 DOI: 10.3390/diagnostics13111836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
Uveal melanoma is one of the most common primary intraocular malignancies that accounts for about 85% of all ocular melanomas. The pathophysiology of uveal melanoma is distinct from cutaneous melanoma and has separate tumor profiles. The management of uveal melanoma is largely dependent on the presence of metastases, which confers a poor prognosis with a one-year survival reaching only 15%. Although a better understanding of tumor biology has led to the development of novel pharmacologic agents, there is increasing demand for minimally invasive management of hepatic uveal melanoma metastases. Multiple studies have already summarized the systemic therapeutic options available for metastatic uveal melanoma. This review covers the current research for the most prevalent locoregional treatment options for metastatic uveal melanoma including percutaneous hepatic perfusion, immunoembolization, chemoembolization, thermal ablation, and radioembolization.
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Affiliation(s)
- Abin Sajan
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Samuel Fordyce
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Andrew Sideris
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Connie Liou
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Zeeshan Toor
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - John Filtes
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Venkatesh Krishnasamy
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Noor Ahmad
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Stephen Reis
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Sidney Brejt
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Asad Baig
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Shaheer Khan
- Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Michael Caplan
- Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - David Sperling
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Joshua Weintraub
- Department of Radiology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
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Ekmekcioglu O, Erdem U, Arican P, Ozvar H, Bostanci O. The value of radioembolisation therapy on metastatic liver tumours - a single centre experience. Nuklearmedizin 2023; 62:214-219. [PMID: 36854382 DOI: 10.1055/a-2026-0851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Local treatments used in metastatic liver tumours efficiently control the disease and survival. Transarterial radioembolisation (TARE) is a safely used locoregional treatment method. We aim to investigate the impact of TARE on different kinds of metastatic liver tumours and the effect of pre-treatment clinical findings. MATERIAL AND METHODS The patients with metastatic liver tumours referred to our department for radioembolisation were retrospectively evaluated. All patients were given a Y-90 glass microsphere after being selected by the appropriate clinical and imaging criteria, lung shunt fraction levels, vascular investigation, and macro aggregated albumin (MAA) scintigraphy performed in the angiography unit. RESULTS Thirty-four (17 women, 17 men) patients were suitable for the treatment. Patients were treated with 115.88±47.84 Gy Y-90 glass Microspheres. The mean survival rate was 14.59±12.59 months after treatment. Higher survival rates were detected in patients who had higher pre-treatment serum albumin levels. The optimum cut-off value of albumin to predict response to treatment was 4 g/dl with 88.89% sensitivity, 62.50% specificity, 72.73% PPV and 83.33% NPV. Furthermore, one unit increase in age increased mortality 1.152 times in our patient group. CONCLUSION Radioembolisation is a safe and efficient method for controlling metastatic liver disease. Albumin levels significantly affect predicting response; higher albumin levels are related to higher survival rates. Furthermore, older age positively correlated with mortality rates in our patient group.
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Affiliation(s)
- Ozgul Ekmekcioglu
- Nuclear Medicine, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
| | - Umut Erdem
- Interventional Radiology Department, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
| | - Pelin Arican
- Nuclear Medicine, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
| | - Hikmet Ozvar
- Radiation Oncology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
| | - Ozgur Bostanci
- Hepatobiliary and General Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkiye
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Hu Q, Xu L, Yi Q, Yuan J, Wu G, Wang Y. miR-204 suppresses uveal melanoma cell migration and invasion through negative regulation of RAB22A. Funct Integr Genomics 2023; 23:49. [PMID: 36705739 DOI: 10.1007/s10142-022-00953-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023]
Abstract
Uveal melanoma (UM), a frequently seen adulthood primary ocular malignancy, shows high aggressiveness. Accumulating studies have revealed the crucial effects of microRNAs (miRNAs) on tumorigenesis and development in various human tumors. miR-204, the cancer-associated miRNA, shows dysregulation and is related to several human malignancies, but its effect on UM remains unknown. The present work focused on exploring miR-204's effect on UM and elucidating its possible molecular mechanisms. According to our results, miR-204 expression markedly increased within both UM tissues and cell lines. As revealed by functional analysis, miR-204 suppressed UM cell invasion and migration. Besides, RAB22A expression decreased through directly binding miR-204 into the corresponding 3' untranslated region (3'UTR) in UM cells. Furthermore, the RAB22A mRNA level increased, which was negatively related to the miR-204 level within UM samples. As revealed by mechanical research, miR-204 exerted its inhibition on the invasion and migration of UM cells via RAB22A. Taken together, this study suggested the tumor-suppressing effect of miR-204 on UM through down-regulating RAB22A. Thus, miR-204 may serve as the new anti-UM therapeutic target.
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Affiliation(s)
- Qidi Hu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Lingli Xu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Quanyong Yi
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Jianshu Yuan
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Guohai Wu
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China
| | - Yuwen Wang
- Department of Ophthalmology, The Affiliated Ningbo Eye Hospital of Wenzhou Medical University, No. 599 Beimingcheng Road, Ningbo, 315040, China.
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Liu C, Tadros G, Smith Q, Martinez L, Jeffries J, Yu Z, Yu Q. Selective internal radiation therapy of metastatic breast cancer to the liver: A meta-analysis. Front Oncol 2022; 12:887653. [PMID: 36505832 PMCID: PMC9729947 DOI: 10.3389/fonc.2022.887653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The aim of this study is to conduct a meta-analysis to assess the efficacy of yttrium-90 selective internal radiation therapy (SIRT) in treating patients with breast cancer with hepatic metastasis. Method PubMed and The Cochrane Library were queried from establishment to January 2021. The following keywords were implemented: "breast", "yttrium", and "radioembolization". The following variables and outcomes were collected: publication year, region, sample size, study design, presence of extrahepatic disease, tumor burden, infused radioactivity, breast cancer subtype, previous treatment, median survival time (MST), length of follow-up, adverse events, and radiographical response such as Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST). Results A total of 24 studies from 14 institutions were included in the present meta-analysis. On the basis of the data from 412 patients, post-embolization MST was 9.8 [95% confidence interval (CI): 9.0-11.6] months. Patients with additional extrahepatic metastasis had a poorer survival rate compared with those with localized hepatic metastasis only (MST: 5.3 vs. 15 months, p < 0.0001). Patients with <25% liver tumor burden exhibited more promising survival than those with >25% (MST: 10.5 vs. 6.8 months, p < 0.0139). On the basis of RECIST, mRECIST, and PERCIST criteria, tumor response rate was 36% (95% CI: 26%-47%), 49% (95% CI: 34%-65%), and 47% (95% CI: 17%-78%), respectively, whereas tumor control rate was 85% (95% CI: 76%-93%), 73% (95% CI: 59%-85%), and 97% (95% CI: 91%-100%), respectively. Conclusion On the basis of the available published evidence, SIRT is feasible and effective in treating patients with breast cancer with liver metastasis. Patients with lower hepatic tumor burden and without extrahepatic metastasis demonstrated more survival benefit. Future randomized controlled trials are warranted.
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Affiliation(s)
- Chenyu Liu
- School of Medicine, George Washington University, Washington DC, United States
| | - George Tadros
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, United States
| | - Quinn Smith
- Kansas City University, College of Osteopathic Medicine, Kansas City, MO, United States
| | - Linda Martinez
- School of Medicine, Ross University, Miramar, FL, United States
| | - James Jeffries
- Interventional Radiology, University of Chicago, Chicago, IL, United States
| | - Zhiyong Yu
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Yu
- Interventional Radiology, University of Chicago, Chicago, IL, United States,*Correspondence: Qian Yu,
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Safety and Efficacy of Ipilimumab plus Nivolumab and Sequential Selective Internal Radiation Therapy in Hepatic and Extrahepatic Metastatic Uveal Melanoma. Cancers (Basel) 2022; 14:cancers14051162. [PMID: 35267470 PMCID: PMC8909598 DOI: 10.3390/cancers14051162] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Despite recent progress on the treatment of metastatic uveal melanoma (mUM), prognosis remains dismal for the majority of patients. Directed liver therapies including selective internal radiation therapy (SIRT) have been the pillar of hepatic metastases management. Independently, immune checkpoint blockade by combination of ipilimumab plus nivolumab has demonstrated a median survival slightly superior to 1 year. However, the benefit of sequential ipilimumab plus nivolumab immunotherapy and SIRT has not been elucidated. Abstract To assess the safety and efficacy of ipilimumab plus nivolumab around selective internal radiation therapy (SIRT) in patients with metastatic uveal melanoma (mUM). We present a retrospective, single center study of 32 patients with mUM divided into two groups based on the treatment received between April 2013 and April 2021. The SIRT_IpiNivo cohort was treated with Yttrium-90 microspheres and ipilimumab plus nivolumab before or after the SIRT (n = 18). The SIRT cohort underwent SIRT but did not receive combined immunotherapy with ipilimumab plus nivolumab (n = 14). Twelve patients (66.7%) of the SIRT_IpiNivo arm received SIRT as first-line treatment and six patients (33.3%) received ipilimumab plus nivolumab prior to SIRT. In the SIRT group, seven patients (50.0%) received single-agent immunotherapy. One patient treated with combined immunotherapy 68 months after the SIRT was included in this group. At the start of ipilimumab plus nivolumab, 94.4% (n = 17) presented hepatic metastases and 72.2% (n = 13) had extra liver disease. Eight patients (44.4%) of the SIRT_IpiNivo group experienced grade 3 or 4 immune related adverse events, mainly colitis and hepatitis. Median overall survival from the diagnosis of metastases was 49.6 months (95% confidence interval (CI); 24.1-not available (NA)) in the SIRT_IpiNivo group compared with 13.6 months (95% CI; 11.5-NA) in the SIRT group (log-rank p-value 0.027). The presence of extra liver metastases at the time of SIRT, largest liver lesion more than 8 cm (M1c) and liver tumor volume negatively impacted the survival. This real-world cohort suggests that a sequential treatment of ipilimumab plus nivolumab and SIRT is a well-tolerated therapeutic approach with promising survival rates.
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Alexander H, Wen D, Chu M, Han C, Hadden P, Thomas R, Bartlett A. Selective internal radiation therapy for hepatic metastases of uveal melanoma: a systematic review. Br J Radiol 2022; 95:20210200. [PMID: 34757824 PMCID: PMC8722257 DOI: 10.1259/bjr.20210200] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Uveal melanoma (UM) commonly metastasizes to the liver. Treatment usually consists of liver-directed therapies, such as selective internal radiation therapy (SIRT). This review aimed to assess the effectiveness and safety of SIRT for hepatic metastases from UM. METHODS The study protocol is available at OSF (https://osf.io/vhyct/). EMBASE and MEDLINE were searched until July 2020, using terms related to SIRT and hepatic metastases from UM. Studies reporting outcomes of SIRT in patients with UM and at least one hepatic metastasis were included. Data on overall survival (OS), hepatic progression free survival (hPFS) or tumor response were collected. The Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. RESULTS 11 studies were included, reporting outcomes for 268 patients with hepatic metastases from UM. Most studies (n = 9, 81.8%) were retrospective. Disease control was achieved in 170 patients (67.5%) and the median OS from time of SIRT was 12.3 months. Median hPFS was 5.4 months. Low-grade side-effects were common but serious complications were infrequent. There were two treatment-related deaths. The median NOS score was 6 (moderate risk of bias). CONCLUSION SIRT appears to be a safe and effective treatment for patients with unresectable hepatic metastases from UM. The certainty of our results is unclear due to predominantly retrospective data with moderate risk of bias. Further prospective studies are required to explore the role of SIRT in UM. ADVANCES IN KNOWLEDGE SIRT appears to be a safe treatment for patients with unresectable hepatic metastases from UM. Further prospective work is required.
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Affiliation(s)
- Harry Alexander
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Daniel Wen
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Michael Chu
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Catherine Han
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter Hadden
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robert Thomas
- Department of Radiology, Imperial College London, London, UK
| | - Adam Bartlett
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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Combination of Immune Checkpoint Inhibitors and Liver-Specific Therapies in Liver-Metastatic Uveal Melanoma: Can We Thus Overcome Its High Resistance? Cancers (Basel) 2021; 13:cancers13246390. [PMID: 34945010 PMCID: PMC8699813 DOI: 10.3390/cancers13246390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 01/10/2023] Open
Abstract
Uveal Melanoma (UM) is a rare disease; however, it is the most common primary intraocular malignant tumor in adults. Hematogenous metastasis, occurring in up to 50% of cases, mainly to the liver (90%), is associated with poor clinical course and treatment failure. In contrast to dramatic benefits of immunotherapy in many tumor entities, as seen in cutaneous melanoma, immune checkpoint inhibitors (ICI) do not achieve comparable results in Metastatic UM (MUM). The aim of this study was to investigate whether the combination of ICI with liver-directed therapies provides a potential survival benefit for those affected. This retrospective, single-center study, including n = 45 patients with MUM, compared the effect of combining ICI with liver-directed therapy ("Cohort 1") with respect to standard therapies ("Cohort 2") on overall survival (OS). Our results revealed a significant survival difference between Cohort 1 (median OS 22.5 months) and Cohort 2 (median OS 11.4 months), indicating that this combination may enhance the efficacy of immunotherapy and thus provide a survival benefit. There is an urgent need for randomized, prospective trials addressing the combination of liver-directed therapies and various strategies of immunotherapy (such as ICI; IMCgp100; personalized vaccines) in order to establish regimens which finally improve the prognosis of patients with MUM.
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Rossi E, Croce M, Reggiani F, Schinzari G, Ambrosio M, Gangemi R, Tortora G, Pfeffer U, Amaro A. Uveal Melanoma Metastasis. Cancers (Basel) 2021; 13:5684. [PMID: 34830841 PMCID: PMC8616038 DOI: 10.3390/cancers13225684] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 02/07/2023] Open
Abstract
Uveal melanoma (UM) is characterized by relatively few, highly incident molecular alterations and their association with metastatic risk is deeply understood. Nevertheless, this knowledge has so far not led to innovative therapies for the successful treatment of UM metastases or for adjuvant therapy, leaving survival after diagnosis of metastatic UM almost unaltered in decades. The driver mutations of UM, mainly in the G-protein genes GNAQ and GNA11, activate the MAP-kinase pathway as well as the YAP/TAZ pathway. At present, there are no drugs that target the latter and this likely explains the failure of mitogen activated kinase kinase inhibitors. Immune checkpoint blockers, despite the game changing effect in cutaneous melanoma (CM), show only limited effects in UM probably because of the low mutational burden of 0.5 per megabase and the unavailability of antibodies targeting the main immune checkpoint active in UM. The highly pro-tumorigenic microenvironment of UM also contributes to therapy resistance. However, T-cell redirection by a soluble T-cell receptor that is fused to an anti-CD3 single-chain variable fragment, local, liver specific therapy, new immune checkpoint blockers, and YAP/TAZ specific drugs give new hope to repeating the success of innovative therapy obtained for CM.
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Affiliation(s)
- Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.R.); (G.S.); (G.T.)
| | - Michela Croce
- Laboratory of Biotherapies, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.C.); (R.G.)
| | - Francesco Reggiani
- Laboratory of Epigenetics, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.R.); (M.A.); (A.A.)
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.R.); (G.S.); (G.T.)
- Medical Oncology, Università Cattolica del S. Cuore, 00168 Rome, Italy
| | - Marianna Ambrosio
- Laboratory of Epigenetics, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.R.); (M.A.); (A.A.)
| | - Rosaria Gangemi
- Laboratory of Biotherapies, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.C.); (R.G.)
| | - Giampaolo Tortora
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (E.R.); (G.S.); (G.T.)
- Medical Oncology, Università Cattolica del S. Cuore, 00168 Rome, Italy
| | - Ulrich Pfeffer
- Laboratory of Epigenetics, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.R.); (M.A.); (A.A.)
| | - Adriana Amaro
- Laboratory of Epigenetics, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.R.); (M.A.); (A.A.)
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13
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Seedor RS, Orloff M, Sato T. Genetic Landscape and Emerging Therapies in Uveal Melanoma. Cancers (Basel) 2021; 13:5503. [PMID: 34771666 PMCID: PMC8582814 DOI: 10.3390/cancers13215503] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 12/12/2022] Open
Abstract
Despite successful treatment of primary uveal melanoma, up to 50% of patients will develop systemic metastasis. Metastatic disease portends a poor outcome, and no adjuvant or metastatic therapy has been FDA approved. The genetic landscape of uveal melanoma is unique, providing prognostic and potentially therapeutic insight. In this review, we discuss our current understanding of the molecular and cytogenetic mutations in uveal melanoma, and the importance of obtaining such information. Most of our knowledge is based on primary uveal melanoma and a better understanding of the mutational landscape in metastatic uveal melanoma is needed. Clinical trials targeting certain mutations such as GNAQ/GNA11, BAP1, and SF3B1 are ongoing and promising. We also discuss the role of liquid biopsies in uveal melanoma in this review.
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Affiliation(s)
- Rino S. Seedor
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (M.O.); (T.S.)
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14
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Carr MJ, Sun J, Cohen JB, Liu J, Serdiuk AA, Stewart SR, Doobay N, Duclos A, Seal DA, Choi J, Zager JS. Over 12 Years Single Institutional Experience Performing Percutaneous Hepatic Perfusion for Unresectable Liver Metastases. Cancer Control 2021; 27:1073274820983019. [PMID: 33372814 PMCID: PMC8480350 DOI: 10.1177/1073274820983019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with unresectable hepatic metastases, from uveal or ocular melanoma, are challenging to treat with an overall poor prognosis. Although over the past decade significant advances in systemic therapies have been made, metastatic disease to the liver, especially from uveal melanoma, continues to be a poor prognosis. Percutaneous hepatic perfusion (PHP) is a safe, viable treatment option for these patients. PHP utilizes high dose chemotherapy delivered directly to the liver while minimizing systemic exposure and can be repeated up to 6 times. Isolation of the hepatic vasculature with a double-balloon catheter allows for high concentration cytotoxic therapy to be administered with minimal systemic adverse effects. A detailed description of the multidisciplinary treatment protocol used at an institution with over 12 years of experience is discussed and recommendations are given. A dedicated team of a surgical or medical oncology, interventional radiology, anesthesiology and a perfusionist allows PHP to be repeatedly performed as a safe treatment strategy for unresectable hepatic metastases.
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Affiliation(s)
- Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan B Cohen
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jinhong Liu
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Andrew A Serdiuk
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Stephen R Stewart
- Certified Clinical Perfusionist, Moffitt Cancer Center, Tampa, FL, USA
| | - Navin Doobay
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Andrew Duclos
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA
| | - David A Seal
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Junsung Choi
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA. Sun is now with the Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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15
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Gonsalves CF, Adamo RD, Eschelman DJ. Locoregional Therapies for the Treatment of Uveal Melanoma Hepatic Metastases. Semin Intervent Radiol 2020; 37:508-517. [PMID: 33328707 DOI: 10.1055/s-0040-1720948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Uveal melanoma is the most common primary intraocular malignant tumor in adults. Approximately 50% of patients develop metastatic disease of which greater than 90% of patients develop hepatic metastases. Following the development of liver tumors, overall survival is dismal with hepatic failure being the cause of death in nearly all cases. To prolong survival for patients with metastatic uveal melanoma, controlling the growth of hepatic tumors is essential. This article will discuss imaging surveillance following the diagnosis of primary uveal melanoma; locoregional therapies used to control the growth of hepatic metastases including chemoembolization, immunoembolization, radioembolization, percutaneous hepatic perfusion, and thermal ablation; as well as currently available systemic treatment options for metastatic uveal melanoma.
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Affiliation(s)
- Carin F Gonsalves
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert D Adamo
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David J Eschelman
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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16
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Role of Natural Killer Cells in Uveal Melanoma. Cancers (Basel) 2020; 12:cancers12123694. [PMID: 33317028 PMCID: PMC7764114 DOI: 10.3390/cancers12123694] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Metastatic Uveal Melanoma (MUM) is a lethal malignancy with no durable treatment available to date. A vast majority of patients with MUM present with liver metastasis. The liver harbors metastatic disease with an apparent lack of a cytotoxic T cell response. It is becoming evident that MUM is not an immunologically silent malignancy and the investigation of non-T cell anti-tumor immunity is warranted. In this review, we highlight the relevance of Natural Killer (NK) cells in the biology and treatment of MUM. Potent anti-NK cell immunosuppression employed by uveal melanoma alludes to its vulnerability to NK cell cytotoxicity. On the contrary, micro-metastasis in the liver survive for several years within close vicinity of a plethora of circulating and liver-resident NK cells. This review provides unique perspectives into the potential role of NK cells in control or progression of uveal melanoma. Abstract Uveal melanoma has a high mortality rate following metastasis to the liver. Despite advances in systemic immune therapy, treatment of metastatic uveal melanoma (MUM) has failed to achieve long term durable responses. Barriers to success with immune therapy include the immune regulatory nature of uveal melanoma as well as the immune tolerant environment of the liver. To adequately harness the anti-tumor potential of the immune system, non-T cell-based approaches need to be explored. Natural Killer (NK) cells possess potent ability to target tumor cells via innate and adaptive responses. In this review, we discuss evidence that highlights the role of NK cell surveillance and targeting of uveal melanoma. We also discuss the repertoire of intra-hepatic NK cells. The human liver has a vast and diverse lymphoid population and NK cells comprise 50% of the hepatic lymphocytes. Hepatic NK cells share a common niche with uveal melanoma micro-metastasis within the liver sinusoids. It is, therefore, crucial to understand and investigate the role of intra-hepatic NK cells in the control or progression of MUM.
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Aaberg TM, Covington KR, Tsai T, Shildkrot Y, Plasseraud KM, Alsina KM, Oelschlager KM, Monzon FA. Gene Expression Profiling in Uveal Melanoma: Five-Year Prospective Outcomes and Meta-Analysis. Ocul Oncol Pathol 2020; 6:360-367. [PMID: 33123530 DOI: 10.1159/000508382] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/30/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction The prognostic 15-gene expression profile (15-GEP) test for uveal melanoma (UM) predicts metastatic risk based on primary tumor biology. Here we report outcomes from a prospective registry of 15-GEP-tested patients, and a meta-analysis with published cohorts. Objectives Management and 5-year clinical outcomes following 15-GEP testing were evaluated. Methods Eighty-nine patients with 15-GEP results were prospectively enrolled at four centers. Physician-recommended management plans were collected, and clinical outcomes tracked every 6 months. Results Eighty percent of Class 1 (low-risk) patients underwent low-intensity management; all Class 2 (high-risk) patients underwent high-intensity management (p < 0.0001). Median follow-up for event-free patients was 4.9 years. Five Class 1 (10%) and 23 Class 2 (58%) tumors metastasized (p < 0.0001). Five-year Class 1 and 2 metastasis-free survival rates were 90% (81-100%) and 41% (27-62%; p < 0.0001), and melanoma-specific survival rates were 94% (87-100%) and 63% (49-82%; p = 0.0007). Class 2 was the only independent predictor of metastasis and was associated with increased risk for metastasis and mortality by meta-analysis. Conclusions UM patient management is guided by 15-GEP testing. Class 2 patients were managed more intensely, in accordance with an observed metastatic rate of >50%; Class 1 patients were safely spared intensive surveillance, resulting in appropriate utilization of healthcare resources.
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Affiliation(s)
- Thomas M Aaberg
- Retina Specialists of Michigan, Michigan State University, Grand Rapids, Michigan, USA
| | | | - Tony Tsai
- Retinal Consultants, Sacramento, California, USA
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18
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Li Y, Shi J, Yang J, Ge S, Zhang J, Jia R, Fan X. Uveal melanoma: progress in molecular biology and therapeutics. Ther Adv Med Oncol 2020; 12:1758835920965852. [PMID: 33149769 PMCID: PMC7586035 DOI: 10.1177/1758835920965852] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/16/2020] [Indexed: 12/15/2022] Open
Abstract
Uveal melanoma (UM) is the most common intraocular malignancy in adults. So far, no systemic therapy or standard treatment exists to reduce the risk of metastasis and improve overall survival of patients. With the increased knowledge regarding the molecular pathways that underlie the oncogenesis of UM, it is expected that novel therapeutic approaches will be available to conquer this disease. This review provides a summary of the current knowledge of, and progress made in understanding, the pathogenesis, genetic mutations, epigenetics, and immunology of UM. With the advent of the omics era, multi-dimensional big data are publicly available, providing an innovation platform to develop effective targeted and personalized therapeutics for UM patients. Indeed, recently, a great number of therapies have been reported specifically for UM caused by oncogenic mutations, as well as other etiologies. In this review, special attention is directed to advancements in targeted therapies. In particular, we discuss the possibilities of targeting: GNAQ/GNA11, PLCβ, and CYSLTR2 mutants; regulators of G-protein signaling; the secondary messenger adenosine diphosphate (ADP)-ribosylation factor 6 (ARF6); downstream pathways, such as those involving mitogen-activated protein kinase/MEK/extracellular signal-related kinase, protein kinase C (PKC), phosphoinositide 3-kinase/Akt/mammalian target of rapamycin (mTOR), Trio/Rho/Rac/Yes-associated protein, and inactivated BAP1; and immune-checkpoint proteins cytotoxic T-lymphocyte antigen 4 and programmed cell-death protein 1/programmed cell-death ligand 1. Furthermore, we conducted a survey of completed and ongoing clinical trials applying targeted and immune therapies for UM. Although drug combination therapy based on the signaling pathways involved in UM has made great progress, targeted therapy is still an unmet medical need.
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Affiliation(s)
- Yongyun Li
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jiahao Shi
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jie Yang
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jianming Zhang
- National Research Center for Translational Medicine, Shanghai State Key Laboratory of Medical Genomics, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200001, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200001, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200001, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 833 Zhizaoju Road, Huangpu District, Shanghai 200001, China
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Mallone F, Sacchetti M, Lambiase A, Moramarco A. Molecular Insights and Emerging Strategies for Treatment of Metastatic Uveal Melanoma. Cancers (Basel) 2020; 12:E2761. [PMID: 32992823 PMCID: PMC7600598 DOI: 10.3390/cancers12102761] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
Uveal melanoma (UM) is the most common intraocular cancer. In recent decades, major advances have been achieved in the diagnosis and prognosis of UM allowing for tailored treatments. However, nearly 50% of patients still develop metastatic disease with survival rates of less than 1 year. There is currently no standard of adjuvant and metastatic treatment in UM, and available therapies are ineffective resulting from cutaneous melanoma protocols. Advances and novel treatment options including liver-directed therapies, immunotherapy, and targeted-therapy have been investigated in UM-dedicated clinical trials on single compounds or combinational therapies, with promising results. Therapies aimed at prolonging or targeting metastatic tumor dormancy provided encouraging results in other cancers, and need to be explored in UM. In this review, the latest progress in the diagnosis, prognosis, and treatment of UM in adjuvant and metastatic settings are discussed. In addition, novel insights into tumor genetics, biology and immunology, and the mechanisms underlying metastatic dormancy are discussed. As evident from the numerous studies discussed in this review, the increasing knowledge of this disease and the promising results from testing of novel individualized therapies could offer future perspectives for translating in clinical use.
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Affiliation(s)
| | | | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (F.M.); (M.S.); (A.M.)
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Meijer TS, Burgmans MC, de Leede EM, de Geus-Oei LF, Boekestijn B, Handgraaf HJM, Hilling DE, Lutjeboer J, Vuijk J, Martini CH, van Erkel AR, van der Meer RW, Tijl FGJ, Speetjens FM, Kapiteijn E, Vahrmeijer AL. Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Ocular Melanoma Metastases Confined to the Liver: A Prospective Phase II Study. Ann Surg Oncol 2020; 28:1130-1141. [PMID: 32761328 PMCID: PMC7801354 DOI: 10.1245/s10434-020-08741-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Indexed: 12/13/2022]
Abstract
Background Ocular melanoma is the most common primary intraocular malignancy and has a very poor prognosis once liver metastases occur. The
aim of this study was to prospectively assess the efficacy and safety of percutaneous hepatic perfusion with melphalan (M-PHP) using the new second-generation
(GEN 2) hemofiltration system in patients with ocular melanoma metastases confined to the liver. Methods Prospective, single-center, single-arm, phase II study including patients with unresectable ocular melanoma metastases confined to the liver. Treatment consisted of two M-PHP procedures at 6–8 weeks interval. Procedures were performed using the CHEMOSAT (GEN 2) system with 3 mg/kg
melphalan. Primary endpoints were overall response rate (ORR) and best overall response (BOR). Secondary endpoints included overall survival (OS), progression-free survival (PFS), hepatic PFS (hPFS), and safety. Results Sixty-four M-PHP procedures were performed in 35 patients between February 2014 and June 2017. The ORR was 72%. BOR was as follows: complete response in 3%, partial response in 69%, stable disease in 13%, and progressive disease in 16%. There was no treatment-related mortality. Fourteen serious adverse events occurred. At a median follow-up of 19.1 months (range 5.6–69.5), median OS was 19.1 months and was significantly longer in responders than in nonresponders (27.5 vs. 11.9 months, p < 0.001). The 1- and 2-year OS was 77% and 43%, respectively. PFS and hPFS were 7.6 and 11.2 months, respectively. Conclusions M-PHP using the GEN 2 filter can achieve a high ORR and prolonged survival in patients with liver-only ocular melanoma metastases.
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Affiliation(s)
- T Susanna Meijer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora M de Leede
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Lutjeboer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Vuijk
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian H Martini
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arian R van Erkel
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Fred G J Tijl
- Department of Extra Corporal Circulation, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank M Speetjens
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Safety and Effectiveness of Yttrium-90 Radioembolization around the Time of Immune Checkpoint Inhibitors for Unresectable Hepatic Metastases. J Vasc Interv Radiol 2020; 31:1233-1241. [PMID: 32741550 DOI: 10.1016/j.jvir.2020.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To assess the safety and effectiveness of yttrium-90 radioembolization and checkpoint inhibitor immunotherapy within a short interval for the treatment of unresectable hepatic metastases. MATERIALS AND METHODS This single-institution retrospective study included 22 patients (12 men; median age, 65 y ± 11) with unresectable hepatic metastases and preserved functional status (Eastern Cooperative Oncology Group performance status 0/1) who received immunotherapy and radioembolization within a 15-month period (median, 63.5 d; interquartile range, 19.7-178.2 d) from February 2013 to March 2018. Primary malignancies were uveal melanoma (12 of 22; 54.5%), soft tissue sarcoma (3; 13.6%), cutaneous melanoma (3; 14%), and others (4; 18.2%). Studies were reviewed to March 2019 to assess Common Terminology Criteria for Adverse Events grade 3/4 toxicities, disease progression, and death. RESULTS There were no grade 4 toxicities within 6 mo of radioembolization. Grade 3 hepatobiliary toxicities occurred in 3 patients (13.6%) within 6 months, 2 from rapid disease progression and 1 from a biliary stricture. Two patients (9.1%) experienced clinical toxicities, including grade 4 colitis at 6 months and hepatic abscess at 3 months. Median overall survival (OS) from first radioembolization was 20 mo (95% confidence interval [CI], 12.5-27.5 mo), and median OS from first immunotherapy was 23 months (95% CI, 15.9-30.1 mo). Within the uveal melanoma subgroup, the median OS from first radioembolization was 17.0 months (95% CI, 14.2-19.8 mo). Median time to progression was 7.8 months (95% CI, 3.3-12.2 mo), and median progression-free survival was 7.8 mo (95% CI, 3.1-12.4 mo). CONCLUSIONS Checkpoint immunotherapy around the time of radioembolization is safe, with a low incidence of toxicity independent of primary malignancy.
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22
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Rowcroft A, Loveday BPT, Thomson BNJ, Banting S, Knowles B. Systematic review of liver directed therapy for uveal melanoma hepatic metastases. HPB (Oxford) 2020; 22:497-505. [PMID: 31791894 DOI: 10.1016/j.hpb.2019.11.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Uveal melanoma (UM) is a rare malignancy with a propensity for metastasis to the liver. Systemic chemotherapy is typically ineffective in these patients with liver metastases and overall survival is poor. There are no evidence-based guidelines for management of UM liver metastases. The aim of this study was to review the evidence for management of UM liver metastases. METHODS A systematic review of English literature publications was conducted across Ovid Medline, Ovid MEDLINE and Cochrane CENTRAL databases until April 2019. The primary outcome was overall survival, with disease free survival as a secondary outcome. RESULTS 55 studies were included in the study, with 2446 patients treated overall. The majority of these studies were retrospective, with 17 of 55 including comparative data. Treatment modalities included surgery, isolated hepatic perfusion (IHP), hepatic artery infusion (HAI), transarterial chemoembolization (TACE), selective internal radiotherapy (SIRT) and Immunoembolization (IE). Survival varied greatly between treatments and between studies using the same treatments. Both surgery and liver-directed treatments were shown to have benefit in selected patients. CONCLUSION Predominantly retrospective and uncontrolled studies suggest that surgery and locoregional techniques may prolong survival. Substantial variability in patient selection and study design makes comparison of data and formulation of recommendations challenging.
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Affiliation(s)
- Alistair Rowcroft
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin P T Loveday
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Benjamin N J Thomson
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Simon Banting
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Brett Knowles
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Seedor RS, Eschelman DJ, Gonsalves CF, Adamo RD, Orloff M, Amjad A, Sharpe-Mills E, Chervoneva I, Shields CL, Shields JA, Mastrangelo MJ, Sato T. An Outcome Assessment of a Single Institution's Longitudinal Experience with Uveal Melanoma Patients with Liver Metastasis. Cancers (Basel) 2020; 12:cancers12010117. [PMID: 31906411 PMCID: PMC7016993 DOI: 10.3390/cancers12010117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/22/2019] [Accepted: 12/30/2019] [Indexed: 12/17/2022] Open
Abstract
There is no FDA-approved treatment for metastatic uveal melanoma (UM) and overall outcomes are generally poor for those who develop liver metastasis. We performed a retrospective single-institution chart review on consecutive series of UM patients with liver metastasis who were treated at Thomas Jefferson University Hospital between 1971–1993 (Cohort 1, n = 80), 1998–2007 (Cohort 2, n = 198), and 2008–2017 (Cohort 3, n = 452). In total, 70% of patients in Cohort 1 received only systemic therapies as their treatment modality for liver metastasis, while 98% of patients in Cohort 2 and Cohort 3 received liver-directed treatment either alone or with systemic therapy. Median Mets-to-Death OS was shortest in Cohort 1 (5.3 months, 95% CI: 4.2–7.0), longer in Cohort 2 (13.6 months, 95% CI: 12.2–16.6) and longest in Cohort 3 (17.8 months, 95% CI: 16.6–19.4). Median Eye Tx-to-Death OS was shortest in Cohort 1 (40.8 months, 95% CI: 37.1–56.9), and similar in Cohort 2 (62.6 months, 95% CI: 54.6–71.5) and Cohort 3 (59.4 months, 95% CI: 56.2–64.7). It is speculated that this could be due to the shift of treatment modalities from DTIC-based chemotherapy to liver-directed therapies. Combination of liver-directed and newly developed systemic treatments may further improve the survival of these patients.
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Affiliation(s)
- Rino S. Seedor
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - David J. Eschelman
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Carin F. Gonsalves
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Robert D. Adamo
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Marlana Orloff
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Anjum Amjad
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Erin Sharpe-Mills
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Inna Chervoneva
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Carol L. Shields
- Oncology Service, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Jerry A. Shields
- Oncology Service, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Michael J. Mastrangelo
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Takami Sato
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Correspondence: ; Tel.: +1-215-955-1195; Fax: +1-215-923-0797
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24
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Levey AO, Elsayed M, Lawson DH, Ermentrout RM, Kudchadkar RR, Bercu ZL, Yushak ML, Newsome J, Kokabi N. Predictors of Overall and Progression-Free Survival in Patients with Ocular Melanoma Metastatic to the Liver Undergoing Y90 Radioembolization. Cardiovasc Intervent Radiol 2019; 43:254-263. [PMID: 31686137 DOI: 10.1007/s00270-019-02366-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/23/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate predictors of overall survival (OS) and progression-free survival (PFS) in patients with ocular melanoma metastatic to the liver undergoing yttrium-90 (Y90) radioembolization, including the effect of concurrent immunotherapy. METHODS An IRB-approved retrospective review of 24 patients with ocular melanoma metastatic to the liver who underwent Y-90 treatment between June 2003 and January 2018 was performed. Data regarding patients' performance status at the time of Y90, intra-/extrahepatic tumor burden, and treatment response were evaluated. RECIST was used to determine objective tumor response. Kaplan-Meier analysis was used to calculate OS and PFS from the first Y90 therapy. Log-rank analysis was used to determine predictors of prolonged OS and PFS. RESULTS Median OS from primary diagnosis and diagnosis of liver metastases was 66 months (mo) and 26.3 mo, respectively. Median OS for those who received immunotherapy within 3 months of undergoing Y90 was prolonged at 26.0 mo versus 9.5 mo for others (p = 0.014). Median OS for patients with an ECOG performance status of 0 was prolonged at 26 mo versus 5.5 mo for others (p = 0.003). Median hepatic PFS was prolonged in patients treated with Y-90 on concurrent immunotherapy at 10.3 mo versus 2.7 mo for TARE only (p = 0.002). Patients with an ECOG performance status of 0 had prolonged PFS (p = 0.002). CONCLUSIONS Concurrent immunotherapy and an ECOG performance status of 0 at the time of Y90 therapy appear to be predictors of prolonged OS and PFS in patients with ocular melanoma metastatic to the liver.
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Affiliation(s)
- Alexa O Levey
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, USA
| | - Mohammad Elsayed
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, USA
| | - David H Lawson
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, USA
| | - Robert M Ermentrout
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, USA
| | - Ragini R Kudchadkar
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, USA
| | - Zachary L Bercu
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, USA
| | - Melinda L Yushak
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, USA
| | - Janice Newsome
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, USA
| | - Nima Kokabi
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, USA.
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25
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Gonsalves CF, Eschelman DJ, Adamo RD, Anne PR, Orloff MM, Terai M, Hage AN, Yi M, Chervoneva I, Sato T. A Prospective Phase II Trial of Radioembolization for Treatment of Uveal Melanoma Hepatic Metastasis. Radiology 2019; 293:223-231. [PMID: 31453767 PMCID: PMC6776232 DOI: 10.1148/radiol.2019190199] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/30/2019] [Accepted: 07/11/2019] [Indexed: 01/05/2023]
Abstract
Background Overall survival (OS) for patients with uveal melanoma (UM) hepatic metastases is extremely poor. Therefore, stabilization of hepatic metastases is essential to prolonging OS. Purpose To assess the safety and effectiveness of radioembolization (RE) for treatment of UM hepatic metastases. Materials and Methods Enrollment for this prospective phase II trial began November 2011 and concluded January 2017. Treatment-naïve participants (group A) and participants who progressed after immunoembolization (group B) with hepatic tumor burden less than 50% underwent RE. Participants were followed for 1 month and every 3 months for acute and delayed toxicities, respectively. MRI, CT, and PET were performed every 3 months to evaluate for tumor response and extrahepatic disease. Participants were followed for at least 2 years or until death. Kaplan-Meier method and multivariable Cox proportional hazard models were used for data analysis. Results In group A, 24 participants (mean age ± standard deviation, 59 years ± 13; 13 men and 11 women) underwent unilobar (n = 7), fractionated whole-liver (n = 1), or sequential lobar (n = 16) RE. One participant was excluded from the trial. Complete response (n = 0), partial response (n = 9), or stable disease (n = 11) was achieved in 20 of 23 (87.0%; 95% confidence interval [CI]: 66.4%, 97.2%) participants. Median progression-free survival from liver metastasis was 8.1 months (95% CI: 6.4, 11.8; range, 3.3-33.7 months). Median OS was 18.5 months (95% CI: 11.3, 23.5; range, 6.5-73.7 months). In group B, 24 participants (mean age, 58 years ± 10; nine men and 15 women) underwent unilobar (n = 5) or sequential lobar (n = 19) RE. Complete response (n = 0), partial response (n = 8), or stable disease (n = 6) was achieved in 14 of 24 (58.3%; 95% CI: 36.3%, 77.9%) participants. Median progression-free survival from liver metastasis was 5.2 months (95% CI: 3.7, 9.8; range, 2.9-22.0 months). Median OS was 19.2 months (95% CI: 11.5, 24.0; range, 4.8-76.6 months). Grade 3 treatment-related toxicities included transient lymphopenia (group A, n = 1; group B, n = 1), pain (group A, n = 2) and nausea or vomiting (group A, n = 1). Conclusion Radioembolization is a promising treatment for patients with uveal melanoma hepatic metastases. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Carin F. Gonsalves
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - David J. Eschelman
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - Robert D. Adamo
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - P. Rani Anne
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - Marlana M. Orloff
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - Mizue Terai
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - Anthony N. Hage
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - Misung Yi
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - Inna Chervoneva
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
| | - Takami Sato
- From the Department of Radiology, Division of Interventional Radiology (C.F.G., D.J.E., R.D.A., A.N.H.), Department of Radiation Oncology (P.R.A.), Department of Medical Oncology (M.O., M.T., T.S.), and Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics (M.Y., I.C.), Sidney Kimmel Medical College at Thomas Jefferson University, Thomas Jefferson University Hospital, 132 S 10th St, Main Building, Suite 766, Philadelphia, Pa 19107
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Putzer D, Schullian P, Bale R. Locoregional ablative treatment of melanoma metastases. Int J Hyperthermia 2019; 36:59-63. [DOI: 10.1080/02656736.2019.1647353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Daniel Putzer
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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27
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Ponti A, Denys A, Digklia A, Schaefer N, Hocquelet A, Knebel JF, Michielin O, Dromain C, Duran R. First-Line Selective Internal Radiation Therapy in Patients with Uveal Melanoma Metastatic to the Liver. J Nucl Med 2019; 61:350-356. [DOI: 10.2967/jnumed.119.230870] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/05/2019] [Indexed: 01/05/2023] Open
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Padia SA. Y90 Clinical Data Update: Cholangiocarcinoma, Neuroendocrine Tumor, Melanoma, and Breast Cancer Metastatic Disease. Tech Vasc Interv Radiol 2019; 22:81-86. [PMID: 31079715 DOI: 10.1053/j.tvir.2019.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While the most compelling levels of evidence for the use of Yttrium-90 (90Y) radioembolization are in patients with hepatocellular carcinoma and hepatic metastases from colorectal cancer, a growing body of literature supports its use in other primary and secondary hepatic malignancies. This includes intrahepatic cholangiocarcinoma, as well as hepatic metastases from neuroendocrine cancer, ocular melanoma, and breast cancer. While is it not feasible to conduct prospective, randomized trials for radioembolization in the setting of these malignancies due to the low overall prevalence of liver-only disease, numerous single-arm studies in the last several years make a compelling argument for its use in select situations. This clinical update summarizes those findings.
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Affiliation(s)
- Siddharth A Padia
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
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29
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New Insights into Molecular Oncogenesis and Therapy of Uveal Melanoma. Cancers (Basel) 2019; 11:cancers11050694. [PMID: 31109147 PMCID: PMC6562554 DOI: 10.3390/cancers11050694] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
Uveal melanoma (UM), which is the most common cancer of the eye, was investigated in recent years by many teams in the field of biomedical sciences and eye clinicians. New knowledge was acquired on molecular pathways found to be dysregulated during the multistep process of oncogenesis, whereas novel therapeutic approaches gave significant results in the clinical applications. Uveal melanoma-affected patients greatly benefited from recent advances of the research in this eye cancer. Tumour biology, genetics, epigenetics and immunology contributed significantly in elucidating the role of different genes and related pathways during uveal melanoma onset/progression and UM treatments. Indeed, these investigations allowed identification of new target genes and to develop new therapeutic strategies/compounds to cure this aggressive melanoma of the eye. Unfortunately, the advances reported in the treatment of cutaneous melanoma have not produced analogous benefits in metastatic uveal melanoma. Nowadays, no systemic adjuvant therapy has been shown to improve overall survival or reduce the risk of metastasis. However, the increasing knowledge of this disease, and the encouraging results seen in clinical trials, offer promise for future effective therapies. Herein, different pathways/genes involved in uveal melanoma onset/progression were taken into consideration, together with novel therapeutic approaches.
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30
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Uveal melanoma: physiopathology and new in situ-specific therapies. Cancer Chemother Pharmacol 2019; 84:15-32. [DOI: 10.1007/s00280-019-03860-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/02/2019] [Indexed: 12/12/2022]
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31
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Erinjeri JP, Fine GC, Adema GJ, Ahmed M, Chapiro J, den Brok M, Duran R, Hunt SJ, Johnson DT, Ricke J, Sze DY, Toskich BB, Wood BJ, Woodrum D, Goldberg SN. Immunotherapy and the Interventional Oncologist: Challenges and Opportunities-A Society of Interventional Oncology White Paper. Radiology 2019; 292:25-34. [PMID: 31012818 DOI: 10.1148/radiol.2019182326] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Interventional oncology is a subspecialty field of interventional radiology that addresses the diagnosis and treatment of cancer and cancer-related problems by using targeted minimally invasive procedures performed with image guidance. Immuno-oncology is an innovative area of cancer research and practice that seeks to help the patient's own immune system fight cancer. Both interventional oncology and immuno-oncology can potentially play a pivotal role in cancer management plans when used alongside medical, surgical, and radiation oncology in the care of cancer patients.
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Affiliation(s)
- Joseph P Erinjeri
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Gabriel C Fine
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Gosse J Adema
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Muneeb Ahmed
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Julius Chapiro
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Martijn den Brok
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Rafael Duran
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Stephen J Hunt
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - D Thor Johnson
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Jens Ricke
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Daniel Y Sze
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Beau Bosko Toskich
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - Bradford J Wood
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - David Woodrum
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
| | - S Nahum Goldberg
- From the Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10065 (J.P.E.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (G.C.F.); Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands (G.J.A., M.d.B.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A.); Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.C.); Department of Radiodiagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland (R.D.); Penn Image-Guided Interventions Laboratory and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.J.H.); Department of Radiology, University of Colorado, Denver, Colo (D.T.J.); Department of Radiology, Ludwig-Maximilian University, Munich, Germany (J.R.); Division of Vascular and Interventional Radiology, Stanford University, Stanford, Calif (D.Y.S.); Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Center for Interventional Oncology, National Cancer Institute, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (B.J.W.); Department of Radiology, Mayo Clinic, Rochester Minn (D.W.); and Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.)
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Tulokas S, Mäenpää H, Peltola E, Kivelä T, Vihinen P, Virta A, Mäkelä S, Kallio R, Hernberg M. Selective internal radiation therapy (SIRT) as treatment for hepatic metastases of uveal melanoma: a Finnish nation-wide retrospective experience. Acta Oncol 2018; 57:1373-1380. [PMID: 29683787 DOI: 10.1080/0284186x.2018.1465587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Finland, selective internal radiation therapy (SIRT) is at present the preferred first-line loco-regional therapy for uveal melanoma patients with hepatic metastases not suitable for surgery. We retrospectively evaluate the outcome and safety of SIRT in this group of patients. MATERIAL AND METHODS Yttrium-90 microspheres were delivered via the hepatic artery into the circulation of metastases from uveal melanoma in 18 patients with a predicted life expectancy of more than three months in three Finnish tertiary referral centers between November 2010 and December 2015. Progression-free survival (PFS), toxicity and overall survival (OS) were evaluated. Patients with historical uveal melanoma without extrahepatic metastases, who had received systemic chemotherapy as first-line treatment for their hepatic metastases at the Helsinki University Hospital between January 2006 and May 2010, were used as a historical control group. RESULTS Partial response and stable disease were observed in three (17%) and eight (44%) patients, respectively; one patient was not evaluable for response. Median PFS after SIRT was 5.6 (range, 1.3-40.8) months. Median OS after SIRT was 13.5 (range, 3.6-44.8) months compared with 10.5 (range, 3.0-16.5; p = .047) months for the historical chemotherapy group. Among patients who received SIRT as first-line treatment, the median OS was 18.7 (range, 8.2-44.8) months, significantly longer than that of the chemotherapy group (10.5 months, p = .017). There were no treatment-related deaths. Toxicity was mainly WHO grade 1-2 and self-limited. CONCLUSION SIRT is a feasible and safe treatment for liver metastases in patients with uveal melanoma.
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Affiliation(s)
- Sanni Tulokas
- Department of Oncology, Comprehensive Cancer Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Mäenpää
- Department of Oncology, Comprehensive Cancer Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erno Peltola
- Department of Radiology, HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tero Kivelä
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Vihinen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Aku Virta
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Siru Mäkelä
- Department of Oncology, Comprehensive Cancer Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Raija Kallio
- Department of Oncology and Haematology, Oulu University Hospital, Oulu, Finland
| | - Micaela Hernberg
- Department of Oncology, Comprehensive Cancer Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Combined Effects of Yttrium-90 Transarterial Radioembolization around Immunotherapy for Hepatic Metastases from Uveal Melanoma: A Preliminary Retrospective Case Series. J Vasc Interv Radiol 2018; 29:1369-1375. [DOI: 10.1016/j.jvir.2018.04.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/25/2018] [Accepted: 04/27/2018] [Indexed: 01/10/2023] Open
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Abbott AM, Doepker MP, Kim Y, Perez MC, Gandle C, Thomas KL, Choi J, Shridhar R, Zager JS. Hepatic Progression-free and Overall Survival After Regional Therapy to the Liver for Metastatic Melanoma. Am J Clin Oncol 2018; 41:747-753. [PMID: 28059929 PMCID: PMC7771287 DOI: 10.1097/coc.0000000000000356] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Regional therapy for metastatic melanoma to the liver represents an alternative to systemic therapy. Hepatic progression-free survival (HPFS), progression-free survival (PFS), and overall survival (OS) were evaluated. MATERIALS AND METHODS A retrospective review of patients with liver metastases from cutaneous or uveal melanoma treated with yttrium-90 (Y90), chemoembolization (CE), or percutaneous hepatic perfusion (PHP) was conducted. RESULTS Thirty patients (6 Y90, 10 PHP, 12 CE, 1 PHP then Y90, 1 CE then PHP) were included. Multivariate analysis showed improved HPFS for PHP versus Y90 (P=0.004), PHP versus CE (P=0.02) but not for CE versus Y90. PFS was also significantly different: Y90 (54 d), CE (52 d), PHP (245 d), P=0.03. PHP treatment and lower tumor burden were significant predictors of prolonged PFS on multivariate analysis. Median OS from time of treatment was longest, but not significant, for PHP at 608 days versus Y90 (295 d) and CE (265 d), P=0.24. Only PHP treatment versus Y90 and lower tumor burden had improved OS on multivariate analysis (P=0.03, 0.03, respectively). CONCLUSIONS HPFS and PFS were significantly prolonged in patients treated with PHP versus CE or Y90. Median OS in PHP patients was over double that seen in Y90 or CE patients but was significant only between PHP and Y90.
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Affiliation(s)
- Andrea M. Abbott
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL
| | - Matthew C. Perez
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Cassandra Gandle
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Junsung Choi
- Department of Interventional Radiology, Moffitt Cancer Center, Tampa, FL
| | - Ravi Shridhar
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
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Boone BA, Perkins S, Bandi R, Santos E, McCluskey K, Bartlett DL, Pingpank JF. Hepatic artery infusion of melphalan in patients with liver metastases from ocular melanoma. J Surg Oncol 2018; 117:940-946. [PMID: 29878390 DOI: 10.1002/jso.24984] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Ocular melanoma has a predilection for liver metastases. Systemic treatment is ineffective and the optimal regional therapy approach is poorly defined. Isolated hepatic perfusion (IHP) with melphalan has emerged as a viable treatment option, however a subset of patients are not candidates for this treatment. We therefore sought to determine if melphalan could be safely administered via the hepatic artery for these patients. METHODS A retrospective review of patients treated with hepatic artery infusion (HAI) of melphalan was undertaken. All patients had contraindications to IHP and were without other therapy options. Melphalan infusion was repeated every four weeks with consideration for dose escalation in the absence of toxicity or significant disease progression. RESULTS Fourteen patients were treated with HAI of melphalan from 2010 to 2015. All patients had hepatic dysfunction or prohibitive tumor volume precluding IHP. There were no procedure-related complications. Three patients (21%) died within 30 days and the median survival was 2.9 months. Elevated baseline bilirubin > 2.5 mg/dL was associated with worse overall survival (0.93 vs 6.3 months, P < 0.05). CONCLUSION HAI of melphalan is safe and feasible for patients with metastatic ocular melanoma. Further study to determine the optimal utilization of this treatment approach is warranted.
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Affiliation(s)
- Brian A Boone
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samantha Perkins
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rupal Bandi
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ernesto Santos
- Department of Radiology, Memorial Sloan Kettering, New York, New York
| | - Kevin McCluskey
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - David L Bartlett
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James F Pingpank
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Park JJ, Diefenbach RJ, Joshua AM, Kefford RF, Carlino MS, Rizos H. Oncogenic signaling in uveal melanoma. Pigment Cell Melanoma Res 2018; 31:661-672. [DOI: 10.1111/pcmr.12708] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022]
Affiliation(s)
- John J. Park
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
| | - Russell J. Diefenbach
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
| | - Anthony M. Joshua
- Melanoma Institute Australia; Sydney New South Wales Australia
- Kinghorn Cancer Centre; St Vincent’s Hospital; Sydney New South Wales Australia
| | - Richard F. Kefford
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
- Department of Medical Oncology; Crown Princess Mary Cancer Centre; Westmead and Blacktown Hospitals; Sydney New South Wales Australia
| | - Matteo S. Carlino
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
- Department of Medical Oncology; Crown Princess Mary Cancer Centre; Westmead and Blacktown Hospitals; Sydney New South Wales Australia
| | - Helen Rizos
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
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Kennedy A, Brown DB, Feilchenfeldt J, Marshall J, Wasan H, Fakih M, Gibbs P, Knuth A, Sangro B, Soulen MC, Pittari G, Sharma RA. Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus. J Gastrointest Oncol 2017; 8:1079-1099. [PMID: 29299370 PMCID: PMC5750172 DOI: 10.21037/jgo.2017.09.10] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/20/2017] [Indexed: 12/12/2022] Open
Abstract
Selective internal radiation therapy (SIRT) with microspheres labelled with the β-emitter yttrium-90 (Y-90) enables targeted delivery of radiation to hepatic tumors. SIRT is primarily used to treat inoperable primary or metastatic liver tumors. Eligible patients have usually been exposed to a variety of systemic anticancer therapies, including cytotoxic agents, targeted biologics, immunotherapy and peptide receptor radionuclide therapy (PRRT). All these treatments have potential interactions with SIRT; however, robust evidence on the safety of these potential combinations is lacking. This paper provides current clinical experiences and expert consensus guidelines for the use of SIRT in combination with the anticancer treatment agents likely to be encountered in clinical practice. It was agreed by the expert panel that precautions need to be taken with certain drugs, but that, in general, systemic therapies do not necessarily have to be stopped to perform SIRT. The authors recommend stopping vascular endothelial growth factor inhibitors 4-6 weeks before SIRT, and restart after the patient has recovered from the procedure. It may also be prudent to stop potent radiosensitizers such as gemcitabine therapy 4 weeks before SIRT, and restart treatment at least 2‒4 weeks later. Data from phase III studies combining SIRT with fluorouracil (5FU) or folinic acid/5FU/oxaliplatin (FOLFOX) suggest that hematological toxicity is more common from the combination than it is from chemotherapy without SIRT. There is no evidence to suggest that chemotherapy increases SIRT-specific gastro-intestinal or liver toxicities.
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Affiliation(s)
- Andrew Kennedy
- Radiation Oncology Research, Sarah Cannon Research Institute, Nashville, Tennessee, USA
| | - Daniel B. Brown
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John Marshall
- Hematology and Oncology Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Harpreet Wasan
- Imperial College, Division of Cancer, Hammersmith Hospital, London, UK
| | - Marwan Fakih
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Peter Gibbs
- Western Hospital, Footscray, Victoria, Australia
| | - Alexander Knuth
- National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra, IDISNA, CIBEREHD, Pamplona, Navarra, Spain
| | - Michael C. Soulen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Ricky A. Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
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Selective Internal Yttrium-90 Radioembolization Therapy (90Y-SIRT) Versus Best Supportive Care in Patients With Unresectable Metastatic Melanoma to the Liver Refractory to Systemic Therapy: Safety and Efficacy Cohort Study. Am J Clin Oncol 2017; 40:27-34. [PMID: 25089529 DOI: 10.1097/coc.0000000000000109] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To investigate survival, efficacy, and safety of selective internal yttrium-90 radioembolization therapy (Y-SIRT) in patients with unresectable metastatic melanoma (MM) to liver refractory to systemic therapy. METHODS An IRB-approved retrospective review of 58 patients diagnosed with unresectable MM to the liver, refractory to systemic therapy, between February 2003 and March 2012 was conducted. Of these, 28 received resin-based Y-SIRT (group A), and 30 patients received best supportive care (group B). Survival was calculated using the Kaplan-Meier method and Cox proportional hazard models. RESULTS Groups A and B were similar for the Child-Pugh class, ECOG scores, age, sex, and race. Median overall survival (OS) from diagnosis of primary melanoma in groups A and B were 119.9 and 26.1 months, respectively (P<0.001). Median OS from hepatic metastasis in groups A and B were 19.9 and 4.8 months, respectively (P<0.0001). In group A, median OS from hepatic metastasis in the Child-Pugh A, B, and C patients was 37.7, 4.2, and 3.6 months, respectively (P<0.001). In group B, median OS from hepatic metastasis in the Child-Pugh A, B, and C patients was 7.8, 4.2, and 1.9 months, respectively (P=0.04). Within group A, median OS from first Y-SIRT was 10.1 months; median OS of the Child-Pugh A, B, and C patients from first Y-SIRT was 10.3, 1.2, and 0.9 months, respectively (P=0.04). Median OS from first Y-SIRT was significantly greater in the absence of diffuse (>10) liver metastases (15.1 vs. 4.7 mo, P=0.02), and in the absence of extrahepatic metastases (21.3 vs. 8.6 mo, P<0.001). Common clinical toxicities following Y-SIRT included abdominal pain (17.9%), fatigue (14.3%), and self-limiting grade III bilirubin toxicity (10.7%). CONCLUSION For patients with unresectable MM to the liver refractory to systemic therapy, resin-based Y was associated with longer survival from liver metastases than best supportive care. Child-Pugh A patients with <10 metastatic lesions and absence of extrahepatic metastases demonstrated greatest survival following Y-SIRT.
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Shamimi-Noori S, Gonsalves CF, Shaw CM. Metastatic Liver Disease: Indications for Locoregional Therapy and Supporting Data. Semin Intervent Radiol 2017; 34:145-166. [PMID: 28579683 DOI: 10.1055/s-0037-1602712] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metastatic liver disease is a major cause of cancer-related morbidity and mortality. Surgical resection is considered the only curative treatment, yet only a minority is eligible. Patients who present with unresectable disease are treated with systemic agents and/or locoregional therapies. The latter include thermal ablation and catheter-based transarterial interventions. Thermal ablation is reserved for those with limited tumor burden. It is used to downstage the disease to enable curative surgical resection, as an adjunct to surgery, or in select patients it is potentially curative. Transarterial therapies are indicated in those with more diffuse disease. The goals of care are to palliate symptoms and prolong survival. The indications and supporting data for thermal ablation and transarterial interventions are reviewed, technical and tumor factors that need to be considered prior to intervention are outlined, and finally several cases are presented.
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Affiliation(s)
- Susan Shamimi-Noori
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Carin F Gonsalves
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Colette M Shaw
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Gordon AC, Uddin OM, Riaz A, Salem R, Lewandowski RJ. Making the Case: Intra-arterial Therapy for Less Common Metastases. Semin Intervent Radiol 2017; 34:132-139. [PMID: 28579681 DOI: 10.1055/s-0037-1601852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intra-arterial therapies have high antitumor activity for both primary and secondary hepatic malignancies. Selective infusions allow increased delivery of cytoreductive therapy to the tumor bed while sparing the normal hepatic parenchyma. These therapies are now often applied in the outpatient setting or with short overnight hospital stays and have a growing role in the treatment of liver-dominant disease from metastatic colorectal cancer and from neuroendocrine tumors. Less commonly, intra-arterial therapies are applied to treat secondary hepatic malignancies from breast cancer, melanoma, pancreatic adenocarcinoma, and soft-tissue sarcomas. The available data are limited and generally retrospective observational cohort series of single institutions. The purpose of this article is to summarize the recent literature on outcomes for intra-arterial therapy in nonsurgical patients. Multi-institutional registries and prospective data are greatly needed, as intra-arterial therapies are increasingly applied in these patients to stop progression of chemorefractory tumors.
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Affiliation(s)
- Andrew C Gordon
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Omar M Uddin
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.,Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.,Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
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Jia Z, Jiang G, Zhu C, Wang K, Li S, Qin X. A systematic review of yttrium-90 radioembolization for unresectable liver metastases of melanoma. Eur J Radiol 2017. [PMID: 28624008 DOI: 10.1016/j.ejrad.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess the effectiveness of yttrium-90 (90Y) radioembolization in the treatment of unresectable liver metastases of melanoma. METHODS PubMed and EMBASE were systemically searched for all English language studies related to 90Y radioembolization for unresectable liver metastases of melanoma, including clinical trials, observational studies, and abstracts from conferences, published between January 1991 and March 2016. RESULTS A total of 12 reports (7 observational studies and 5 abstracts from conferences) involving 255 patients were included in the analysis. The primary sites of melanoma were cutaneous (n=22; 8.6%), ocular (n=197; 77.3%), rectal (n=3; 1.2%), and unknown (n=33; 12.9%). The median disease control rate at 3 months was 73.6% (range, 58.3%-88.9%). Among the 207 patients for whom tumor response at 3 months was reported, complete response was seen in 1.0% (2/207), partial response was seen in 19.3% (40/207), stable disease was seen in 46.9% (97/207), and progressive disease was seen in 32.9% (68/207). The median survival was 10 months (range, 7-13.4 months), and the median 1-year survival rate was 34.6% (range, 23%-80%). Complications of 90Y radioembolization were reported in 13 cases. The most common side effects were fatigue (median, 36.1%), abdominal pain (median, 17.8%), and nausea (median, 15.0%). CONCLUSIONS 90Y radioembolization is a promising alternative therapy for the treatment of unresectable liver metastases of melanoma, with encouraging effects on disease control and survival. Some complications can occur, and side effects are frequent but mild.
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Affiliation(s)
- Zhongzhi Jia
- Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, 213003, China
| | - Guomin Jiang
- Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, 213003, China
| | - Chunfu Zhu
- Department of General Surgery, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China
| | - Kai Wang
- Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, 213003, China
| | - Shaoqin Li
- Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, 213003, China
| | - Xihu Qin
- Department of General Surgery, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.
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Vogl TJ, Koch SA, Lotz G, Gebauer B, Willinek W, Engelke C, Brüning R, Zeile M, Wacker F, Vogel A, Radeleff B, Scholtz JE. Percutaneous Isolated Hepatic Perfusion as a Treatment for Isolated Hepatic Metastases of Uveal Melanoma: Patient Outcome and Safety in a Multi-centre Study. Cardiovasc Intervent Radiol 2017; 40:864-872. [PMID: 28144756 DOI: 10.1007/s00270-017-1588-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/25/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Percutaneous isolated hepatic perfusion (PIHP) with Melphalan has been developed as a treatment for patients with isolated hepatic metastases of uveal melanoma. We discuss patient outcome and safety in a retrospective multi-centre study. MATERIALS AND METHODS Between 2012 and 2016 18 patients with un-resectable isolated hepatic metastases of uveal melanoma received single or repeated PIHP with Melphalan (n = 35) at seven sites. Progression-free time, overall survival time (OS) and tumour response by means of RECIST 1.1 criteria were evaluated. Peri- and post-procedural adverse events (AE) were registered. Patients' life quality was assessed using four-point scale questionnaires. RESULTS Of 18 patients, initial PIHP treatment resulted in partial response (PR) in eight, stable disease (SD) in seven and progressive disease (PD) in three cases. Nine patients underwent second PIHP with PR in eight cases and PD in one case. Six patients were evaluated after third PIHP with PR in five patients and SD in one patient. Two patients received fourth PIHP with PD in both cases. Median OS was 9.6 months (range 1.6-41.0 months). Median progression-free survival time was 12.4 months (range 0.9-41.0 months) with 1-year survival of 44%. Most common post-procedural AE grade 3 and 4 were temporary leukopenia (n = 11) and thrombocytopenia (n = 8). Patients' self-assessments showed good ratings for overall health and quality of life with only slight changes after PIHP, and a high degree of satisfaction with PIHP treatment. CONCLUSION PIHP with Melphalan proved to be a relatively safe, minimal-invasive and repeatable treatment for patients with non-resectable hepatic metastases of uveal melanoma.
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Silvia A Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Gösta Lotz
- Department of Anesthesiology, Intensive-Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Bernhard Gebauer
- Department of Diagnostic and Interventional Radiology, Campus Charité Mitte, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Winfried Willinek
- Department of Diagnostic and Interventional Radiology, Brüderkrankenhaus Trier, Nordallee 1, 54292, Trier, Germany
| | - Christoph Engelke
- Department of Diagnostic and Interventional Radiology, Evangelisches Krankenhaus Göttingen-Weende gGmbH, An der Lutter 24, 37075, Göttingen, Germany
| | - Roland Brüning
- Department of Diagnostic and Interventional Radiology, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - Martin Zeile
- Department of Diagnostic and Interventional Radiology, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Voßstraße 2, 69115, Heidelberg, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. .,Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge StreetSuite 400, Boston, MA, 02141, USA.
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Padia SA, Lewandowski RJ, Johnson GE, Sze DY, Ward TJ, Gaba RC, Baerlocher MO, Gates VL, Riaz A, Brown DB, Siddiqi NH, Walker TG, Silberzweig JE, Mitchell JW, Nikolic B, Salem R. Radioembolization of Hepatic Malignancies: Background, Quality Improvement Guidelines, and Future Directions. J Vasc Interv Radiol 2017; 28:1-15. [DOI: 10.1016/j.jvir.2016.09.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 02/09/2023] Open
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Ma J, Gimenez JM, Sandow T, Devun D, Kirsch D, Gulotta P, Gilbert P, Kay D. Intraarterial Liver-Directed Therapies: The Role of Interventional Oncology. Ochsner J 2017; 17:412-416. [PMID: 29230127 PMCID: PMC5718455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Since the early 1990s, the minimally invasive image-guided therapies used in interventional oncology to treat hepatocellular carcinoma have continued to evolve. Additionally, the range of applications has been expanded to the treatment of hepatic metastases from colorectal cancer, neuroendocrine tumors, cholangiocarcinoma, breast cancer, melanoma, and sarcoma. METHODS We searched the literature to identify publications from 1990 to the present on various image-guided intraarterial therapies and their efficacy, as well as their role in the management of primary and secondary liver malignancies. RESULTS Chemoembolization and radioembolization are considered a standard of care in treating, delaying progression of disease, and downstaging to bridge to liver transplantation. Progression-free survival and overall survival outcomes are promising in patients with colorectal cancer and neuroendocrine tumors with liver metastases. Applications in the treatment of hepatic metastases from cholangiocarcinoma, breast cancer, melanoma, and sarcoma also show potential. CONCLUSION Interventional oncology and its image-guided intraarterial therapies continue to gain recognition as treatment options for primary and secondary liver cancers. Growing evidence supports their role as a standard of care alongside medical oncology, surgery, and radiation oncology.
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Affiliation(s)
- Jenson Ma
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Juan Martin Gimenez
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Tyler Sandow
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Daniel Devun
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - David Kirsch
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Paul Gulotta
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Patrick Gilbert
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Dennis Kay
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Liver Metastases From Noncolorectal Malignancies (Neuroendocrine Tumor, Sarcoma, Melanoma, Breast). Cancer J 2016; 22:381-386. [DOI: 10.1097/ppo.0000000000000232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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46
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Yttrium-90 Microsphere Brachytherapy for Liver Metastases From Uveal Melanoma: Clinical Outcomes and the Predictive Value of Fluorodeoxyglucose Positron Emission Tomography. Am J Clin Oncol 2016; 39:189-95. [PMID: 24441583 DOI: 10.1097/coc.0000000000000033] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To report outcomes after yttrium-90 microsphere brachytherapy for unresectable liver metastases from uveal melanoma and to evaluate factors predictive for overall survival (OS) and hepatic progression-free survival (PFS). METHODS A total of 71 patients were consecutively treated with microsphere brachytherapy for unresectable liver metastases from uveal melanoma between 2007 and 2012. Clinical, radiographic, and positron emission tomography-derived, functional tumor parameters were evaluated by log-rank test in univariate analysis and backwards stepwise multivariate Cox proportional hazards regression. OS and hepatic PFS were estimated by Kaplan-Meier analysis. RESULTS A total of 134 procedures were performed in 71 patients with a median age of 63 years (range, 23 to 91 y). Fifty-eight patients (82%) received microsphere brachytherapy as a salvage therapy. Median hepatic PFS and OS after microsphere brachytherapy were 5.9 months (range, 1.3 to 19.1 mo) and 12.3 months (range, 1.9 to 49.3 mo), respectively. Median OS times after diagnosis of liver metastases was 23.9 months (range, 6.2 to 69.0 mo). In univariate analysis, female sex, pretreatment metabolic tumor volume, and total glycolic activity (TGA) were significantly correlated with hepatic PFS and OS. In multivariate analysis, female sex and TGA retained significance as independent predictors of hepatic PFS and OS. A low pretreatment TGA (<225 g) was associated with a significantly longer median OS than was a TGA≥225 g (17.2 vs. 9.7 mo, P=0.01). CONCLUSIONS Yttrium-90 microsphere brachytherapy provided favorable survival times in patients with unresectable liver metastases from uveal melanoma. Metabolic tumor volume and TGA are predictive functional tumor parameters, which may aid patient selection and risk stratification.
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Chattopahdyay C, Kim DW, Gombos D, Oba J, Qin Y, Williams M, Esmaeli B, Grimm E, Wargo J, Woodman S, Patel S. Uveal melanoma: From diagnosis to treatment and the science in between. Cancer 2016; 122:2299-312. [PMID: 26991400 PMCID: PMC5567680 DOI: 10.1002/cncr.29727] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 12/25/2022]
Abstract
Melanomas of the choroid, ciliary body, and iris of the eye are collectively known as uveal melanomas. These cancers represent 5% of all melanoma diagnoses in the United States, and their age-adjusted risk is 5 per 1 million population. These less frequent melanomas are dissimilar to their more common cutaneous melanoma relative, with differing risk factors, primary treatment, anatomic spread, molecular changes, and responses to systemic therapy. Once uveal melanoma becomes metastatic, therapy options are limited and are often extrapolated from cutaneous melanoma therapies despite the routine exclusion of patients with uveal melanoma from clinical trials. Clinical trials directed at uveal melanoma have been completed or are in progress, and data from these well designed investigations will help guide future directions in this orphan disease. Cancer 2016;122:2299-2312. © 2016 American Cancer Society.
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Affiliation(s)
| | - Dae Won Kim
- Moffitt Cancer Center, Tampa, Florida, United States
| | - Dan Gombos
- MD Anderson Cancer Center, Houston, Texas, United States
| | - Junna Oba
- MD Anderson Cancer Center, Houston, Texas, United States
| | - Yong Qin
- MD Anderson Cancer Center, Houston, Texas, United States
| | | | - Bita Esmaeli
- MD Anderson Cancer Center, Houston, Texas, United States
| | | | - Jennifer Wargo
- MD Anderson Cancer Center, Houston, Texas, United States
| | - Scott Woodman
- MD Anderson Cancer Center, Houston, Texas, United States
| | - Sapna Patel
- MD Anderson Cancer Center, Houston, Texas, United States
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Bozkurt MF, Salanci BV, Uğur Ö. Intra-Arterial Radionuclide Therapies for Liver Tumors. Semin Nucl Med 2016; 46:324-39. [DOI: 10.1053/j.semnuclmed.2016.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mahnken AH. Current status of transarterial radioembolization. World J Radiol 2016; 8:449-459. [PMID: 27247711 PMCID: PMC4882402 DOI: 10.4329/wjr.v8.i5.449] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/17/2015] [Accepted: 03/14/2016] [Indexed: 02/07/2023] Open
Abstract
Unresectable primary and secondary liver malignancies present a major problem in the treatment of solid tumors. Transarterial radioembolization (TARE) is an increasingly used technique for treating various types of malignant liver tumors. This approach is appealing, as the mechanism of action is independent from other loco-regional treatments and potentially complementary to systemic therapies. There are two commercially available products in use for TARE: 90Y-resin and 90Y-glass microspheres. Currently available data indicates TARE so be safe and effective in hepatocellular carcinoma (HCC) and metastatic liver disease. In HCC the results compare well with chemoembolization, while the role of TARE in combination with kinase inhibitors has yet to be established. Current data on TARE in metastatic liver disease is promising, but there is a strong need for prospective randomized trials comparing TARE and modern chemotherapeutic regimen to support the growing role of TARE in metastatic liver disease.
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Stereotactic Radiofrequency Ablation for Metastatic Melanoma to the Liver. Cardiovasc Intervent Radiol 2016; 39:1128-35. [PMID: 27055850 DOI: 10.1007/s00270-016-1336-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/25/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the outcome of patients with melanoma liver metastasis treated with stereotactic radiofrequency ablation (SRFA). MATERIAL AND METHOD Following IRB approval, a retrospective evaluation of the treatment of 20 patients with 75 melanoma liver metastases was performed. RESULTS A median number of 2 lesions (range 1-14) per patient with a median size of 1.7 cm (range 0.5-14.5 cm) were treated. 67 lesions were <3 cm (89.3 %) and 8 lesions were >3 cm (10.7 %). Per patient a median of 1 ablation session was performed (range: 1-4) totaling 34 sessions. There were no procedure-related deaths and all major complications (n = 3) could be easily treated by pleural drainages. The primary and secondary success rates were 89.3 and 93.3 %, respectively. The overall local recurrence rate was 13.3 %. Four of ten local recurrences were re-treated successfully by SRFA. During follow-up, 9/20 patients developed extrahepatic metastatic disease and 10/20 had liver recurrence at any location. The median OS from the date of SRFA was 19.3 months, with an OS of 64, 41, and 17 % at 1, 3, and 5 years, with no significant difference for patients with cutaneous and ocular melanoma. The median DFS after SRFA for all 20 patients was 9.5 months, with 37, 9, and 0 % at 1, 3, and 5 years. CONCLUSIONS Due to the high local curative potential and the promising long-term survival rates associated with minimal morbidity and mortality, radiofrequency ablation seems to be an attractive alternative to resection in patients with melanoma liver metastases.
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