title: Perfusion and infusion for melanoma in-transit metastases in the era of effective systemic therapy.
abstract: The management of melanoma in-transit metastases (IT-mets) is challenging. For many years, the absence of effective systemic therapy has prompted physicians to focus on regional therapies for melanoma confined to the limb. The introduction of isolated limb perfusion (ILP) and isolated limb infusion (ILI) has enabled effective delivery of cytotoxic drugs in an isolated circuit, so as to overcome systemic toxicity and maximize local response. Both techniques have evolved over years and both tumor necrosis factor (TNF)-alpha-based ILP and ILI have distinct indications. The development of new systemic treatment options for patients with melanoma in the past decade has shed a new light on melanoma therapy. The present manuscript focuses on the modern role of ILI and ILP in the treatment of patients with melanoma with in-transit metastases in the era of effective systemic therapy. The response and control rates of ILI/ILP are still superior to rates achieved with systemic agents. The extent of disease in patients with stage III disease, however, warrants effective systemic treatment to prolong survival. There is great potential in combining rapid response therapy such as ILI/ILP with systemic agents for sustainable response. Trial results are eagerly awaited.
authors.affiliation: From the Erasmus MC Cancer Institute, Rotterdam, Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Grünhagen
authors.affiliation: From the Erasmus MC Cancer Institute, Rotterdam, Netherlands.
authors.forename: Hidde M
authors.initials: HM
authors.lastname: Kroon
authors.affiliation: From the Erasmus MC Cancer Institute, Rotterdam, Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D009362:Neoplasm Metastasis; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan