RESUMEN
BACKGROUND: Uveal melanoma (UM) has a poor prognosis once liver metastases occur. The melphalan/Hepatic Delivery System (melphalan/HDS) is a drug/device combination used for liver-directed treatment of metastatic UM (mUM) patients. The purpose of the FOCUS study was to assess the efficacy and safety of melphalan/HDS in patients with unresectable mUM. METHODS: Eligible patients with mUM received treatment with melphalan (3.0 mg/kg ideal body weight) once every 6 to 8 weeks for a maximum of six cycles. The primary end point was the objective response rate (ORR). The secondary end points included duration of response (DOR), overall survival (OS), and progression-free survival (PFS). RESULTS: The study enrolled 102 patients with mUM. Treatment was attempted in 95 patients, and 91 patients received treatment. In the treated population (n = 91), the ORR was 36.3 % (95 % confidence interval [CI], 26.44-47.01), including 7.7 % of patients with a complete response. Thus, the study met its primary end point because the lower bound of the 95 % CI for ORR exceeded the upper bound (8.3 %) from the benchmark meta-analysis. The median DOR was 14 months, and the median OS was 20.5 months, with an OS of 80 % at 1 year. The median PFS was 9 months, with a PFS of 65 % at 6 months. The most common serious treatment-emergent adverse events were thrombocytopenia (15.8 %) and neutropenia (10.5 %), treated mostly on an outpatient basis with observation. No treatment-related deaths were observed. CONCLUSION: Treatment with melphalan/HDS provides a clinically meaningful response rate and demonstrates a favorable benefit-risk profile in patients with unresectable mUM (study funded by Delcath; ClinicalTrials.gov identifier: NCT02678572; EudraCT no. 2015-000417-44).
Asunto(s)
Antineoplásicos Alquilantes , Neoplasias Hepáticas , Melanoma , Melfalán , Neoplasias de la Úvea , Humanos , Melanoma/tratamiento farmacológico , Melanoma/patología , Melanoma/secundario , Melanoma/mortalidad , Melfalán/administración & dosificación , Masculino , Femenino , Persona de Mediana Edad , Neoplasias de la Úvea/tratamiento farmacológico , Neoplasias de la Úvea/patología , Neoplasias de la Úvea/mortalidad , Anciano , Adulto , Tasa de Supervivencia , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/tratamiento farmacológico , Estudios de Seguimiento , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/uso terapéutico , Pronóstico , Anciano de 80 o más Años , Sistemas de Liberación de MedicamentosAsunto(s)
Antineoplásicos Alquilantes , Melanoma , Melfalán , Neoplasias de la Úvea , Humanos , Melanoma/tratamiento farmacológico , Melanoma/patología , Melanoma/secundario , Melfalán/administración & dosificación , Neoplasias de la Úvea/tratamiento farmacológico , Neoplasias de la Úvea/patología , Antineoplásicos Alquilantes/administración & dosificación , Tasa de Supervivencia , Pronóstico , Estudios de Seguimiento , Sistemas de Liberación de Medicamentos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/tratamiento farmacológicoRESUMEN
Melanoma surveillance guidelines vary. Melanoma recurrence patterns and detection methods were examined. Resected melanoma patients were reviewed. Recurrence detection included patient complaint (PC), physical exam (PE), cross-sectional imaging (CSI), and ultrasound (US). 276 patients were included: 131 stage I, 83 stage II, and 62 stage III. Recurrence rates were 8%, 24%, and 27%, respectively. For stage I patients, 46% of recurrences were local, 18% regional, and 36% distant. Patient complaint identified 55% of recurrences, PE 36%, and CSI 9%. For stage II, 20% of recurrences were local, 20% regional, and 60% distant. Patient complaint identified 35% of recurrences, PE 20%, and CSI 45%. For stage III, 6% of recurrences were local, 53% regional, and 41% distant. Patient complaint identified 17% of recurrences, PE 12%, CSI 59%, and US 12%. Average time to recurrence by stage was 23.7, 24.6, and 17.7 months, respectively. H&P for all melanoma patients and CSI for higher stages are effective surveillance strategies.