Abstract
In-transit metastases occur in approximately 3% of melanoma patients, can be very symptomatic and survival in this group may be prolonged. Regional chemotherapy with melphalan delivered by isolated limb perfusion (ILP) or isolated limb infusion (ILI) are effective treatment options which are generally well tolerated. ILI is a less invasive and simpler alternative to ILP. ILI is tolerated better than ILP, though is probably less effective. Complete response rates are 45- 69% for ILP and 23-44% for ILI. The limb is often warmed to lower temperatures in ILI compared to ILP and the limb becomes progressively more hypoxic and acidotic during ILI, each of these parameters potentially having an effect on outcome. ILP & ILI are used primarily as palliative options when excision of in-transit metastases is unfeasible but can be used as an adjunctive procedure to surgery, for other tumour types such as merkel cell carcinoma, and can be repeated if indicated. For ILI correction of melphalan dose for ideal body weight has been shown to substantially decrease the rates of severe local toxicity while maintaining complete response rates, but overall response rate is reduced. Combination treatment with tumour necrosis factor α has been used with variable outcomes and new combinations with buthionine sulfoximine and ADH-1 are being investigated.
Keywords: Melphalan, Melanoma, Chemotherapy, Regional chemotherapy, Isolated limb infusion, Isolated limb perfusion, intransit metastases, symptomatic, acidotic, tumour necrosis factor, cutaneous papules, systemic toxicity, systemic anticoagulation, myelosuppression, Muscle necrosis
Current Topics in Medicinal Chemistry
Title: Melphalan in Regional Chemotherapy for Locally Recurrent Metastatic Melanoma
Volume: 12 Issue: 1
Author(s): C.L. Defty and J.R. Marsden
Affiliation:
Keywords: Melphalan, Melanoma, Chemotherapy, Regional chemotherapy, Isolated limb infusion, Isolated limb perfusion, intransit metastases, symptomatic, acidotic, tumour necrosis factor, cutaneous papules, systemic toxicity, systemic anticoagulation, myelosuppression, Muscle necrosis
Abstract: In-transit metastases occur in approximately 3% of melanoma patients, can be very symptomatic and survival in this group may be prolonged. Regional chemotherapy with melphalan delivered by isolated limb perfusion (ILP) or isolated limb infusion (ILI) are effective treatment options which are generally well tolerated. ILI is a less invasive and simpler alternative to ILP. ILI is tolerated better than ILP, though is probably less effective. Complete response rates are 45- 69% for ILP and 23-44% for ILI. The limb is often warmed to lower temperatures in ILI compared to ILP and the limb becomes progressively more hypoxic and acidotic during ILI, each of these parameters potentially having an effect on outcome. ILP & ILI are used primarily as palliative options when excision of in-transit metastases is unfeasible but can be used as an adjunctive procedure to surgery, for other tumour types such as merkel cell carcinoma, and can be repeated if indicated. For ILI correction of melphalan dose for ideal body weight has been shown to substantially decrease the rates of severe local toxicity while maintaining complete response rates, but overall response rate is reduced. Combination treatment with tumour necrosis factor α has been used with variable outcomes and new combinations with buthionine sulfoximine and ADH-1 are being investigated.
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Cite this article as:
Defty C.L. and Marsden J.R., Melphalan in Regional Chemotherapy for Locally Recurrent Metastatic Melanoma, Current Topics in Medicinal Chemistry 2012; 12 (1) . https://dx.doi.org/10.2174/156802612798919187
DOI https://dx.doi.org/10.2174/156802612798919187 |
Print ISSN 1568-0266 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4294 |
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