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Surgery after immunotherapy may extend OS in patients with metastatic melanoma
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NEW YORK — Complete metastasectomy after high-dose interleukin-2 therapy may prolong OS in patients with metastatic melanoma, according to results of a retrospective chart review presented at HemOnc Today Melanoma and Cutaneous Malignancies.
Clinicians at Saint Louis University perform potentially curative resection after systemic therapy when possible to improve overall response in patients with stage IV melanoma.
Melinda B. Chu, MD, an internist at Saint Louis University, along with Eddy C. Hsueh, MD, and John M. Richart, MD, both of Saint Louis University, evaluated survival outcomes among patients with metastatic melanoma who underwent complete metastasectomies after high-dose interleukin-2 (HD IL-2) therapy. Researchers compared those outcomes with the expected survival after systemic therapy alone as established in the MSLT-1 trial.
Melinda B. Chu
The analysis included 55 patients treated at Saint Louis University between January 1999 and June 2011. They all achieved at least partial response to HD IL-2 therapy.
Patients had received HD IL-2 via IV in doses of 720,000 IU/kg. The regimen consisted of 14 doses per cycle, with two cycles per course and a maximum of two courses.
Eight patients achieved complete response and three achieved unresectable partial response.
Three achieved partial response and were able to undergo resection. Of these:
l The first presented with bone, lung and lymph node metastases but, after HD IL-2 treatment, only lymph node metastases remained.
l The second presented with gallbladder, lung and lymph node metastases but, after HD IL-2 treatment, only gallbladder metastases remained.
l The third presented with several lung nodules. After HD IL-2 treatment, the number of nodules decreased and those that remained appeared amenable to complete metastasectomy.
The first patient (39.5 months) and second patient (17.9 months) achieved longer survival duration than that expected for patients with stage IVC (6.3 months). The third patient survived for 19 months, or twice as long as the expected 9.1 months for those with stage IVB disease.
“Performing complete metastasectomy after HD IL-2 when possible had favorable results on overall survival in this small series,” Chu and colleagues wrote. “Though systemic therapy was not utilized initially to be a ‘neoadjuvant’ therapy in this retrospective review, we believe the combination of surgery and immunotherapy in the management of metastatic melanoma to eradicate residual tumor burden may improve outcomes and warrants further evaluation.” – by Kristie L. Kahl
Disclosure: The researchers report no relevant financial disclosures.
Reference: Chu MB, et al. Complete metastasectomy after high-dose interleukin-2 (HD IL-2) therapy for melanoma. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 18-19, 2016; New York.