Predicting Disease Progression After Regional Therapy for In-Transit Melanoma Disease Progression After Regional Therapy

Lidsky ME, Turley RS, Beasley GM, et al. — Sat, 01 Jun 2013 00:00:00 GMT

Importance

Although approximately 30% to 50% of patients experience a complete response after regional chemotherapy for in-transit melanoma, a subset of patients will develop rapidly progressive disease. In the current era of an expanding armamentarium, including both regional and systemic options for treating advanced melanoma, identifying perioperative factors that predict disease progression may obviate unnecessary morbidity associated with regional therapy and avoid delays in systemic therapy.

Objective

To identify patient-related clinical and pathological variables, as well as procedural factors, that correlate with disease progression.

Design

Using a prospectively maintained database, we identified patients who either underwent first-time melphalan-based isolated limb infusion (ILI) or first-time hyperthermic isolated limb perfusion (HILP) for in-transit melanoma. Response was defined using modified Response Evaluation Criteria in Solid Tumors for cutaneous disease at 3 months after treatment. Survival analyses were performed using the Kaplan-Meier method, with the differences in survival curves compared using a log-rank test. Potential preoperative and procedural predictors of in-field progressive disease were analyzed using logistic regression.

Participants

Of the 258 patients included in the database, 215 were identified as having undergone first-time regional therapy. Of these 215 patients, 134 underwent ILI, and 81 underwent HILP.

Exposure

Regional therapy (ILI or HILP).

Main Outcomes and Measures

Complete response or progressive disease.

Results

Of 134 patients who underwent ILI, 43 (32.1%) experienced in-field progressive disease. Of 81 patients who underwent HILP, 9 (11.1%) experienced in-field progressive disease. The median survival for patients with in-field progressive disease was 20.3 months for the ILI cohort and 15.0 months for the HILP cohort. In general, patients with progressive disease were younger, with advanced-stage melanoma and increased tumor burden. Compared with patients who experienced a complete response, patients with in-field progressive disease after ILI were younger (odds ratio, 1.06 [95% CI, 0.90-0.98]; P = .002). For patients who underwent HILP, no clinically relevant preoperative predictors of in-field progressive disease were identified. Procedural variables, including chemotherapeutic dosing, degree of acidosis or base deficit achieved, and peak temperature attained, were not predictors of in-field progressive disease after ILI or HILP.

Conclusions and Relevance

Patient, clinical, and procedural factors are unreliable predictors of in-field progressive disease after regional therapy in patients with in-transit melanoma. Defining the potential utility of molecular markers in predicting response or failure of regional therapy should be the focus of future research efforts.

Having Trouble Making Predictions Comment on “Predicting Disease Progression After Regional Therapy for In-Transit Melanoma” Having Trouble Making Predictions

Kemeny M. — Sat, 01 Jun 2013 00:00:00 GMT

Trying to predict which patients will have progressive disease after certain treatments has been one of the main problems of cancer care. Using retrospective analyses of any database to find prognostic indicators is difficult at any time, but it is especially difficult if the number of patients is small because multivariate analysis of all other factors cannot be used effectively. To find predictive variables in a database of 258 patients, which is what the study by Lidsky et al tried to accomplish, is practically impossible. Thus, the finding that there were no significant predictors of response just underlines the fact that their study did not include enough patients to get this information.

JAMA Surgery: Skin Cancer Topic Collection

Predicting Disease Progression After Regional Therapy for In-Transit Melanoma Disease Progression After Regional Therapy

Having Trouble Making Predictions Comment on “Predicting Disease Progression After Regional Therapy for In-Transit Melanoma” Having Trouble Making Predictions