Treatment strategies with electrochemotherapy for limb in-transit melanoma: Real-world outcomes from a European, retrospective, cohort study.

IF 3.5 2区医学 Q2 ONCOLOGY Ejso Pub Date : 2024-10-05 DOI:10.1016/j.ejso.2024.108740

Luca G Campana, Francesca Tauceri, Joana Bártolo, Sarah Calabrese, Joy Odili, Giulia Carrara, Victor Farricha, Dario Piazzalunga, Kriszta Bottyán, Kamal Bisarya, Matteo Mascherini, James A Clover, Serena Sestini, Maša Bošnjak, Erika Kis, Fabrizio Fantini, Piero Covarelli, Matteo Brizio, Leela Sayed, Carlo Cabula, Rosanna Careri, Tommaso Fabrizio, Klaus Eisendle, Alastair MacKenzie Ross, Hadrian Schepler, Lorenzo Borgognoni, Gregor Sersa, Sara Valpione

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Abstract

Background: This study analysed treatment strategies with electrochemotherapy (ECT) in melanoma with limb in-transit metastases (ITM).

Methods: We audited AJCC v.8 stage IIIB-IIID patients treated across 22 centres (2006-2020) within the International Network for Sharing Practices of ECT (InspECT).

Results: 452 patients were included, 58 % pre-treated (93 % had lower limb ITM, 44 % had ≤10 metastases [median size 1.5 cm]. Treatment strategies included first-line ECT (n = 145, 32 %), ECT with concurrent locoregional/systemic treatment (n = 163, 36 %), and salvage ECT (n = 144, 32 %). The objective response rate was 63 % (complete response [CR], 24 %), increasing to 74 % (CR, 39 %) following retreatment (median two ECT, range 1-8). CR rate in treatment-naïve and pre-treated patients was 50 % vs 32 % (p < 0.001). Bleomycin de-escalation was associated with lower CR (p = 0.004). Small tumour number and size, hexagonal electrode, retreatment, and post-ECT skin ulceration predicted response in multivariable analysis. At a median follow-up of 61 months, local and locoregional recurrence occurred in 55 % and 81 % of patients. Median local progression-free, new lesions-free, and regional recurrence-free survival were 32.9, 6.9, and 7.7 months. Grade-3 toxicity was 15 %. Concurrent treatment and CR correlated with improved regional control and survival. Concomitant checkpoint inhibition did not impact toxicity or survival outcomes. The median overall survival was 5.7 years.

Conclusions: Among patients with low-burden limb-only ITM, standard-dose bleomycin ECT results in durable local response. Treatment naivety, low tumour volume, hexagonal electrode application, retreatment, and post-ECT ulceration predict response. CR and concurrent treatment correlate with improved regional control and survival outcomes. Combination with checkpoint inhibitors is safe but lacks conclusive support.

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肢体转移性黑色素瘤的电化学疗法治疗策略：一项欧洲回顾性队列研究的真实结果。

背景：本研究分析了电化学疗法（ECT）治疗肢体转移性黑色素瘤的策略：本研究分析了电化学疗法（ECT）对伴有肢端转移（ITM）的黑色素瘤的治疗策略：我们对国际电化学疗法实践分享网络（InspECT）内22个中心（2006-2020年）治疗的AJCC v.8 IIIB-IIID期患者进行了审计：共纳入452名患者，其中58%接受过预处理（93%有下肢ITM，44%有≤10个转移灶[中位尺寸为1.5厘米]）。治疗策略包括一线电疗（145人，32%）、同时进行局部/系统治疗的电疗（163人，36%）和挽救性电疗（144人，32%）。客观反应率为 63%（完全反应 [CR]，24%），再治疗后增加到 74%（CR，39%）（中位数为两次 ECT，范围为 1-8）。未接受治疗和接受过治疗的患者的 CR 率分别为 50% 和 32%（P，结论）：在低负担的肢端 ITM 患者中，标准剂量博莱霉素 ECT 可产生持久的局部反应。治疗新手、肿瘤体积小、六角形电极应用、再治疗和ECT后溃疡可预测反应。CR 和同期治疗与区域控制和生存结果的改善相关。与检查点抑制剂联合治疗是安全的，但缺乏确凿的支持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.