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Carr MJ , Sun J , Kroon HM , Miura JT , Beasley GM , Farrow NE , Mosca PJ , Lowe MC , Farley CR , Kim Y , Naqvi SMH , Kirichenko DA , Potdar A , Daou H , Mullen D , Farma JM , Henderson MA , Speakman D , Serpell J , Delman KA , Smithers BM , Coventry BJ , Tyler DS , Thompson JF , Zager JS
Oncologic Outcomes After Isolated Limb Infusion for Advanced Melanoma: An International Comparison of the Procedure and Outcomes Between the United States and Australia
Ann Surg Oncol. 2020 Dec;27(13) :5107-5118
PMID: 32918177    PMCID: PMC7674259    URL: https://www.ncbi.nlm.nih.gov/pubmed/32918177
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Abstract
BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose chemotherapy to extremities affected by locally advanced or in-transit melanoma. This study compared the outcomes of melanoma patients treated with ILI in the United States of America (USA) and Australia (AUS). METHODS: Patients with locally recurrent in-transit melanoma treated with ILI at USA or AUS centers between 1992 and 2018 were identified. Demographic and clinicopathologic characteristics were collected. Primary outcomes of treatment response, in-field progression-free survival (IPFS), distant progression-free survival (DPFS), and overall survival (OS) were evaluated by the Kaplan-Meier method. Multivariable analysis evaluated whether availability of new systemic therapies affected outcomes. RESULTS: More ILIs were performed in AUS (n = 411, 60 %) than in the USA (n = 276, 40 %). In AUS, more ILIs were performed for stage 3B disease than in the USA (62 % vs 46 %; p < 0.001). The reported complete response rates were similar (AUS 30 % vs USA 29 %). Among the stage 3B patients, AUS patients had better IPFS (p = 0.001), whereas DPFS and OS were similar between the two countries. Among the stage 3C patients, the USA patients had better OS (p < 0.001), whereas IPFS and DPFS were similar. Availability of new systemic therapies did not affect IPFS or DPFS in either country. However, the USA patients who received ILI after ipilimumab approval in 2011 had significantly improved OS (hazard ratio, 0.62; p = 0.013). CONCLUSIONS: AUS patients were treated at an earlier disease stage than the USA patients with better IPFS for stage 3B disease. The USA patients treated after the availability of new systemic therapies had a better OS.
Notes
1534-4681 Carr, Michael J Orcid: 0000-0001-6233-4004 Sun, James Kroon, Hidde M Miura, John T Beasley, Georgia M Farrow, Norma E Mosca, Paul J Lowe, Michael C Farley, Clara R Kim, Youngchul Naqvi, Syeda Mahrukh Hussnain Kirichenko, Dennis A Potdar, Aishwarya Daou, Hala Mullen, Dean Farma, Jeffrey M Henderson, Michael A Speakman, David Serpell, Jonathan Delman, Keith A Smithers, B Mark Coventry, Brendon J Tyler, Douglas S Thompson, John F Zager, Jonathan S Orcid: 0000-0002-6886-4468 K08 CA237726/CA/NCI NIH HHS/United States Journal Article United States Ann Surg Oncol. 2020 Sep 11. doi: 10.1245/s10434-020-09051-y.