Intra-arterial hepatic fotemustine for the treatment of liver metastases from uveal melanoma: experience in 101 patients.
BACKGROUND
Exclusive liver metastases occur in up to 40% of patients with uveal melanoma associated with a median survival of 2-7 months. Single agent response rates with commonly available chemotherapy are below 10%. We have investigated the use of fotemustine via direct intra-arterial hepatic (i.a.h.) administration in patients with uveal melanoma metastases.


METHODS
A total of 101 patients from seven centers were treated with i.a.h. fotemustine, administered intra-arterially weekly for a 4-week induction period, and then as a maintenance treatment every 3 weeks until disease progression, unacceptable toxicity or patient refusal.


RESULTS
A median of eight fotemustine infusions per patient were delivered (range 1-26). Catheter related complications occurred in 23% of patients; however, this required treatment discontinuation in only 10% of the patients. The overall response rate was 36% with a median overall survival of 15 months and a 2-year survival rate of 29%. LDH, time between diagnosis and treatment start and gender were significant predictors of survival.


CONCLUSIONS
Locoregional treatment with fotemustine is well tolerated and seems to improve outcome of this poor prognosis patient population. Median survival rates are among the longest reported and one-third of the patients are still alive at 2 years.
Peters
S
S
Centre Pluridisciplinaire d'Oncologie and Département de Chirurgie, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland.
Voelter
V
V
Zografos
L
L
Pampallona
S
S
Popescu
R
R
Gillet
M
M
Bosshard
W
W
Fiorentini
G
G
Lotem
M
M
Weitzen
R
R
Keilholz
U
U
Humblet
Y
Y
Piperno-Neumann
S
S
Stupp
R
R
Leyvraz
S
S
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008545:Melanoma / Q000188:drug therapy*; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000008:administration & dosage*; D009943:Organophosphorus Compounds / Q000008:administration & dosage*; D014604:Uveal Neoplasms / Q000188:drug therapy*
D000970:Antineoplastic Agents; D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; C054368:fotemustine