title: Metastatic melanoma to the liver: a contemporary and comprehensive review of surgical, systemic, and regional therapeutic options.
abstract: Effective management of hepatic metastases from ocular and cutaneous melanoma remains a major therapeutic challenge. Treatment options include hepatic resection, hepatic intra-arterial (HIA) chemotherapy, chemoembolization, and hepatic perfusions. Evaluating the efficacy of these interventions is limited by the retrospective nature of most of the data, although controlled phase 3 studies are starting to emerge. Studies of hepatic resection are strongly suggestive of a survival benefit following surgery in selected patients. Effective systemic agents for metastatic cutaneous melanoma are available and supported by randomized controlled phase 3 trials. In contrast, no active systemic treatment has yet been identified for metastatic ocular melanoma. HIA and intravenous delivery of fotemustine have been compared in a randomized phase 3 trial in patients with unresectable metastases from melanoma, but no differences between the 2 approaches were observed. Hepatic arterial chemoembolization appears only to be moderately effective according to uncontrolled studies; targeting patients with less liver involvement may improve outcomes. A recent phase 3 study showed a significant improvement in hepatic progression-free survival with percutaneous hepatic perfusion compared with best alternative care in patients with metastatic melanoma; however, the overall survival analysis was confounded by crossover of control patients to active treatment. In conclusion, hepatic resection offers the possibility of long-term survival in carefully selected patients with liver-limited metastases from melanoma. In patients with unresectable cutaneous melanoma, effective systemic therapy is the best treatment option. For patients with unresectable ocular melanoma, regional treatments are likely to assume a greater role until effective systemic treatments are identified.
authors.affiliation: Department of Hematology/Oncology, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Sanjiv S
authors.initials: SS
authors.lastname: Agarwala
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Steven
authors.initials: S
authors.lastname: O'Day
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D016461:Chemoembolization, Therapeutic; D010478:Chemotherapy, Cancer, Regional Perfusion; D018572:Disease-Free Survival; D005134:Eye Neoplasms / Q000473:pathology*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008545:Melanoma / Q000556:secondary*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D016896:Treatment Outcome; D000096142:Cutaneous Malignant Melanoma
keywords: chemoembolization; cutaneous melanoma; hepatic intra-arterial infusion; hepatic metastases; ocular melanoma; perfusion; review; surgery; systemic therapy