Sunday, January 20, 2019

In-transit melanoma metastases and PV-10 vs isolated limb perfusion, an update...

I have been writing about intralesional/intratumoral treatments for melanoma for a LOOOOONG time!  My first post was about PV-10 in 2012!!! If you're interested for a walk back in time and the initial thoughts, here you go:  Rose Bengal sustains high response rate in Melanoma patients!!!  Here are a zillion posts/articles regarding intralesional treatments since, with the last being in December of 2018:  Intralesional therapy for melanoma ~ from TVEK, PV-10, CAVATAK, to SD101 and beyond!

I have also been keeping an eye on its use for those with in-transit melanoma as well.  Here are posts specific to that:  In-transit Melanoma

And for the purposes of comparison, relative to the article at hand, here are some posts on isolated limb perfusion: 

From 2014:  In-Transit Melanoma..a little info
From 2018:  Chemo via isolated limb perfusion followed by ipi = response rate of 85% in 26 melanoma patients 

Now there is this updated by Read, et al:

Patients with in-transit melanoma metastases have comparable survival outcomes following isolated limb infusion or intralesional PV-10-A propensity score matched, single center study. Read, Fayers, Thomas, et al. J Surg Oncol. 2019 Jan 15.

Isolated limb infusion (ILI) and intralesional PV-10 are well described locoregional therapies for in-transit melanoma. The objective of this study was to assess the effect of these treatments on survival outcomes within a cohort matched for key characteristics.  Patients were treated using ILI or intralesional PV-10 at a single institution and the data prospectively recorded. Propensity score matching was performed using key covariates within a logistic regression model. The primary outcome was the melanoma-specific survival.

Seventy-two patients nonrandomized were successfully matched. Both treatments produced similar best overall responses. The median melanoma-specific survival (MSS) was 74.4 months from ILI and 36.4 months from PV-10 treatments. Within the ILI subgroup, the 12-, 24-, 36- and 60-month MSS rates were 85.3%, 75.3%, 60.1%, and 60.1%, respectively. From the time of PV-10 the corresponding 12-, 24-, 36-, and 60-month MSS rates were 82.6%, 70.0%, 53.9%, and 35.9%. On multivariate analysis, there was a significant difference in survival comparing completely with noncomplete responders.  These findings demonstrate that ILI and PV-10 treatments for in-transit disease produce comparable long-term survival. Both therapies have reproducible response rates and predominantly localized and tolerable side-effects.

While ain't nuthin a done deal in melanoma land, I am glad that intralesionals are proving helpful to more melanoma patients and melanoma researchers are working toward finding the best ways to utilize it on its own and in combination with systemic therapies for the greatest benefit.  I hope that more intralsional options, in addition to TVEC, will be FDA approved soon.  I long for head to head comparisons.  Still - it is progress and that is good.  Thanks, ratties. - c

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