Michael J Carr1, James Sun1, Hidde M Kroon2,3, John T Miura1,4, Georgia M Beasley5, Norma E Farrow5, Paul J Mosca5, Michael C Lowe6, Clara R Farley6, Youngchul Kim7, Syeda Mahrukh Hussnain Naqvi7, Dennis A Kirichenko8, Aishwarya Potdar8, Hala Daou8, Dean Mullen2, Jeffrey M Farma9, Michael A Henderson10, David Speakman10, Jonathan Serpell11, Keith A Delman7, B Mark Smithers12, Brendon J Coventry3, Douglas S Tyler13, John F Thompson3,14,15, Jonathan S Zager16,17. 1. Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 2. Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. 3. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. 4. 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. 5. Department of Surgery, Duke University, Durham, NC, USA. 6. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 7. Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 8. University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL, USA. 9. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. 10. Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia. 11. Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia. 12. Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia. 13. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. 14. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 15. Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia. 16. Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Jonathan.Zager@moffitt.org. 17. Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA. Jonathan.Zager@moffitt.org.
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.
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 melanomapatients 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.
Authors: Christy Y Chai; Jeremiah L Deneve; Georgia M Beasley; Suroosh S Marzban; Y Ann Chen; Bhupendra Rawal; Stephen R Grobmyer; Steven N Hochwald; Douglas S Tyler; Jonathan S Zager Journal: Ann Surg Oncol Date: 2011-12-06 Impact factor: 5.344
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Authors: Charles M Balch; Jeffrey E Gershenwald; Seng-Jaw Soong; John F Thompson; Michael B Atkins; David R Byrd; Antonio C Buzaid; Alistair J Cochran; Daniel G Coit; Shouluan Ding; Alexander M Eggermont; Keith T Flaherty; Phyllis A Gimotty; John M Kirkwood; Kelly M McMasters; Martin C Mihm; Donald L Morton; Merrick I Ross; Arthur J Sober; Vernon K Sondak Journal: J Clin Oncol Date: 2009-11-16 Impact factor: 44.544
Authors: Diego J Muilenburg; Georgia M Beasley; Zachary J Thompson; Ji-Hyun Lee; Douglas S Tyler; Jonathan S Zager Journal: Ann Surg Oncol Date: 2014-09-06 Impact factor: 5.344
Authors: Cristina O'Donoghue; Matthew C Perez; John E Mullinax; Danielle Hardman; Sean Sileno; Syeda Mahrukh Hussnain Naqvi; Youngchul Kim; Ricardo J Gonzalez; Jonathan S Zager Journal: Ann Surg Oncol Date: 2017-10-10 Impact factor: 5.344
Authors: Hidde M Kroon; Brendon J Coventry; Mitchell H Giles; Michael A Henderson; David Speakman; Mark Wall; Andrew Barbour; Jonathan Serpell; Paul Paddle; Alexander G J Coventry; Thomas Sullivan; Bernard Mark Smithers; John F Thompson Journal: Ann Surg Oncol Date: 2015-11-18 Impact factor: 5.344