title: Hepatic arterial Fotemustine chemotherapy in patients with liver metastases from cutaneous melanoma is as effective as in ocular melanoma.
abstract: OBJECTIVE
  Hepatic metastases from melanoma are associated with poor prognosis. Systemic chemotherapy and biological treatments remain unsatisfactory. This study investigated the impact of hepatic arterial chemotherapy in patients with ocular and cutaneous melanoma.
  
  
  METHODS
  In a retrospectively analysed observational study, 36 consecutive patients with hepatic metastases from ocular or cutaneous melanoma were assigned for surgical hepatic port-catheter implantation. Fotemustine was delivered weekly for a 4-week period, followed by a 5-week rest and a maintenance period every 3 weeks until progression. Overall survival, response and toxicity were analysed and compared.
  
  
  RESULTS
  After port-catheter implantation 30/36 patients were finally treated (18 with ocular and 12 with cutaneous melanoma). A median of 8 infusions per patient were delivered (range 3-24). 30% thrombocytopenia grade >or=3, 7% neutropenia grade >or=3 but no nausea or vomiting grade >or=3 were encountered. Nine out of 30 patients achieved partial remission, 10/30 stable disease; 11/30 patients were progressive. Median survival for all treated patients was 14 months. Partial remission and stable disease were associated with a survival advantage compared to progressive disease (19 vs. 5 months). No significant difference in survival was observed for ocular versus cutaneous melanoma. Serum LDH was a significant predictor of both response and survival.
  
  
  CONCLUSIONS
  Hepatic arterial Fotemustine chemotherapy was well tolerated. Meaningful response and survival rates were achieved in ocular as well as cutaneous melanoma. Careful patient selection in consideration of extra-hepatic involvement is crucial for the effectiveness of this treatment. Independent from the primary melanoma site, it is debatable if patients with highly elevated serum-LDH may benefit from this approach.
authors.affiliation: Department of Surgery and Surgical Oncology, Charité-Universitätsmedizin Berlin, Campus Buch, Robert-Rössle-Tumour-Hospital at Helios Klinikum Berlin-Buch, D-13125 Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Siegel
authors.forename: A
authors.initials: A
authors.lastname: Hauschild
authors.forename: C
authors.initials: C
authors.lastname: Kettelhack
authors.forename: K C
authors.initials: KC
authors.lastname: Kähler
authors.forename: A
authors.initials: A
authors.lastname: Bembenek
authors.forename: P M
authors.initials: PM
authors.lastname: Schlag
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005134:Eye Neoplasms / Q000473:pathology; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000008:administration & dosage*; D009943:Organophosphorus Compounds / Q000008:administration & dosage*; D012878:Skin Neoplasms / Q000473:pathology; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; C054368:fotemustine