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Oncologic Outcomes After Isolated Limb Infusion for Advanced Melanoma: An International Comparison of the Procedure and Outcomes Between the United States and Australia

  • Melanoma
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Abstract

Background

Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose chemotherapy to extremities affected by locally advanced or in-transit melanoma. This study compared the outcomes of melanoma patients treated with ILI in the United States of America (USA) and Australia (AUS).

Methods

Patients with locally recurrent in-transit melanoma treated with ILI at USA or AUS centers between 1992 and 2018 were identified. Demographic and clinicopathologic characteristics were collected. Primary outcomes of treatment response, in-field progression-free survival (IPFS), distant progression-free survival (DPFS), and overall survival (OS) were evaluated by the Kaplan-Meier method. Multivariable analysis evaluated whether availability of new systemic therapies affected outcomes.

Results

More ILIs were performed in AUS (n = 411, 60 %) than in the USA (n = 276, 40 %). In AUS, more ILIs were performed for stage 3B disease than in the USA (62 % vs 46 %; p < 0.001). The reported complete response rates were similar (AUS 30 % vs USA 29 %). Among the stage 3B patients, AUS patients had better IPFS (p = 0.001), whereas DPFS and OS were similar between the two countries. Among the stage 3C patients, the USA patients had better OS (p < 0.001), whereas IPFS and DPFS were similar. Availability of new systemic therapies did not affect IPFS or DPFS in either country. However, the USA patients who received ILI after ipilimumab approval in 2011 had significantly improved OS (hazard ratio, 0.62; p = 0.013).

Conclusions

AUS patients were treated at an earlier disease stage than the USA patients with better IPFS for stage 3B disease. The USA patients treated after the availability of new systemic therapies had a better OS.

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Acknowledgments

The study was supported by the Biostatistics and Bioinformatics Shared Resources at Moffitt Cancer Center, Tampa, FL (P30-CA076292).

Author information

Author notes

  1. John T. Miura MD

    Present address: Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania Perelman, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Authors and Affiliations

  1. Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Michael J. Carr MD, MS, James Sun MD, John T. Miura MD & Jonathan S. Zager MD

  2. Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia

    Hidde M. Kroon MD, PhD & Dean Mullen MD

  3. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

    Hidde M. Kroon MD, PhD, Brendon J. Coventry MBBS, PhD & John F. Thompson MD

  4. Department of Surgery, Duke University, Durham, NC, USA

    Georgia M. Beasley MD, MHS, Norma E. Farrow MD & Paul J. Mosca MD

  5. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Michael C. Lowe MD, MA & Clara R. Farley MD

  6. Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Youngchul Kim PhD, Syeda Mahrukh Hussnain Naqvi MD, MPH & Keith A. Delman MD

  7. University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Dennis A. Kirichenko MS, Aishwarya Potdar MS & Hala Daou BS

  8. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Jeffrey M. Farma MD

  9. Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia

    Michael A. Henderson MBBS, BMedSc & David Speakman MBBS

  10. Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia

    Jonathan Serpell MBBS, MEd

  11. Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia

    B. Mark Smithers MBBS

  12. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

    Douglas S. Tyler MD

  13. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    John F. Thompson MD

  14. Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson MD

  15. Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Jonathan S. Zager MD

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  1. Michael J. Carr MD, MS
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Corresponding author

Correspondence to Jonathan S. Zager MD.

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Disclosure

Jonathan S. Zager was issued USA patent no. 10,583,246 for high-flow isolated limb infusion and has an additional high-flow ILI patent pending. John F. Thompson has received honoraria for advisory board participation from Merck Sharpe Dohme Australia and Bristol Myers Squibb Australia. He also has received honoraria and travel expenses from GSK and Provectus Inc. Consultant Regeneron 2019. The remaining authors have no conflicts of interest.

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John F. Thompson and Jonathan S. Zager are co-senior authors.

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Carr, M.J., Sun, J., Kroon, H.M. et al. Oncologic Outcomes After Isolated Limb Infusion for Advanced Melanoma: An International Comparison of the Procedure and Outcomes Between the United States and Australia. Ann Surg Oncol 27, 5107–5118 (2020). https://doi.org/10.1245/s10434-020-09051-y

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