Isolated-limb chemo reins in advanced melanoma

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For people with advanced but localized melanoma, delivering potent chemotherapy to just the limb with the cancer is highly effective both in terms of local disease control and survival, Dutch clinicians report.

This approach, they say in the December Annals of Surgery, “should be considered in all cases of limb-threatening tumors or in situations where simple surgical procedures to obtain local control fail.”

The technique involves clamping off the affected limb with a tourniquet, while maintaining circulation in the isolated region with an external pump similar to a heart-lung machine. The limb can then be perfused with very high concentrations of chemo drugs, notably with a powerful agent called tumor necrosis factor, TNF.

In their article, Dr. Dirk J. Grunhagen and colleagues from the Daniel den Hoed Cancer Center in Rotterdam report their experience with 100 TNF-based isolated-limb perfusions performed over a 12-year period in 87 patients with advanced melanoma

A complete response was achieved by 69 percent of the subjects and a partial response by 26 percent, with the remaining 5 percent having no change in their condition.

Side effects of the treatment were “mild to moderate in almost all cases,” the team reports, “with no treatment-related death and one treatment-related amputation.”

Overall, 55 percent of the patients experienced local progression of the melanoma after an average of 16 months, and the estimated survival after five years was 32 percent.

For people who had a complete response, the numbers were better, with local progression noted in 52 percent after an average of 22 months and a five-year survival rate of 42 percent.

At present, Grunhagen’s team concludes, isolated limb perfusion with TNF is “the most efficacious” procedure for patients with limb-threatening melanoma that cannot be dealt with surgically.

SOURCE: Annals of Surgery, December 2004.

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