Liver resection for metastatic melanoma with postoperative tumor-infiltrating lymphocyte therapy.
BACKGROUND
Patients with metastatic melanoma to the liver (MML) have a median survival of 4 to 6 months. This study evaluated patients who underwent liver resection with intent to receive postoperative tumor-infiltrating lymphocyte (TIL) therapy.


METHODS
Retrospective analysis of a prospective database identified patients with MML who underwent liver resection from 1980 to 2008.


RESULTS
A total of 539 patients had MML, and 39% (204 of 539) had tumor collected for TIL. A total of 17% (35 of 204) underwent liver resection for TIL. The 3-year overall survival was 53%. Lack of extrahepatic disease (P = .026), negative margin (P = .056), and single hepatic metastasis (P = .04) predicted survival after univariate analysis. Only lack of extrahepatic disease remained a significant predictor of survival after multivariate analysis (P = .043). A total of 31% (11 of 35) underwent complete resection without TIL, and 69% (24 of 35) underwent resection with synchronous intrahepatic and extrahepatic disease with intent to receive TIL. For 9 of 11 patients (2 of 11 excluded for gene therapy), 3-year survival was 80%. A total of 4 (44%) of 9 experienced recurrence, with a median disease-free survival of 1.2 years. For 24 patients (69%) with residual disease, 3-year survival was 51% (2 of 24 excluded for gene therapy). A total of 63% (15 of 24) received postoperative TIL (3-year survival 65%), and 29% (7 of 24) did not. A total of 40% (6 of 15) had disease that partially responded to TIL; the disease of 67% (4 of 6) had not progressed at median follow-up of 55 months (range, 42-197+ months). The seven patients who did not receive TIL had a median survival of 4.6 months.


CONCLUSIONS
Resection of MML with TIL should be considered because it can result in prolonged survival in a highly selected group of patients.
Ripley
R Taylor
RT
Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Davis
Jeremy L
JL
Klapper
Jacob A
JA
Mathur
Aarti
A
Kammula
Udai
U
Royal
Richard E
RE
Yang
James C
JC
Sherry
Richard M
RM
Hughes
Marybeth S
MS
Libutti
Steven K
SK
White
Donald E
DE
Steinberg
Seth M
SM
Dudley
Mark E
ME
Rosenberg
Steven A
SA
Avital
Itzhak
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016219:Immunotherapy, Adoptive; D008113:Liver Neoplasms / Q000276:immunology / Q000556:secondary / Q000628:therapy*; D016246:Lymphocytes, Tumor-Infiltrating; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult