Factors predicting progressive disease in melanoma patients investigated
medwireNews: Demographic, clinical, and procedural factors should not be used to predict the likelihood of progression after regional therapy for "in-transit" or early metastatic melanoma, say researchers.
Instead, "defining the potential utility of molecular markers in predicting response or failure of regional therapy should be the focus of future research efforts," they suggest.
Michael Lidsky, Duke University Medical Center, Durham, North Carolina, USA, and colleagues recruited 215 patients with in-transit melanoma undergoing either first-time melphalan-based isolated limb infusion (ILI) or first-time hyperthermic isolated limb perfusion (HILP) treatment.
Response to treatment was assessed at 3 months using the modified Response Evaluation Criteria in Solid Tumors. Overall, 32.1% of the ILI and 11.1% of the HILP patients had experienced disease progression at follow up and a respective 29.9% and 44.4% of the two groups had a complete response to treatment.
When the patients who experienced progression and those who had a complete response to treatment were compared, the patients who experienced disease progression were younger, had increased tumor burden, and were more likely to have advanced-stage melanoma than those who did not.
Lidsky and team then evaluated possible factors associated with progression versus complete response in each treatment group, and found that ILI-treated patients with progressive disease were significantly younger than those with a complete response (odds ratio=1.06). However, no significant demographic, clinical, or procedural factors were associated with progression in the patients who received HILP therapy.
Despite the fact that 30-50% of patients receiving regional chemotherapy experience a complete response, a small percentage do not respond to therapy and develop rapid disease progression, explains the team.
"We conclude from our study that patient-related clinical and pathological variables, as well as procedural factors, cannot reliably predict progressive disease after regional therapy for advanced melanoma of the extremities," write Lidsky et al in JAMA Surgery. They add that they plan to continue to recommend regional therapy until more sensitive techniques for predicting progression are developed.
"Further research in the realm of molecular markers in the context of tumor signatures, as well as research to determine the potential benefit of immunologic augmentation, may be the key to identifying patients most likely to benefit from regional therapy and therefore improve their survival and eliminate unnecessary morbidity," they conclude.
By Helen Albert, Senior medwireNews Reporter