Liver resection and ablation for metastatic melanoma: A single center experience

Doussot, Alexandre; Nardin, Charlée; Takaki, Haruyuki; Litchman, Tess; D’Angelica, Michael I.; Jarnagin, William R.; Postow, Michael A.; Erinjeri, Joseph P.; Kingham, T. Peter

doi:10.1002/jso.23929

Cited by 23 publications

(15 citation statements)

References 42 publications

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“…Multimodality and multidisciplinary management of metastatic disease includes the use of percutaneous thermal ablation, a modality associated with durable local control and oncologic outcomes comparable to surgery . In this study, we sought to evaluate whether in situ melanoma vaccination could be achieved by three local directed therapies combined with intralesional GM‐CSF.…”

Section: Discussionmentioning

confidence: 99%

Endogenous Heat-Shock Protein Induction with or Without Radiofrequency Ablation or Cryoablation in Patients with Stage IV Melanoma

et al. 2017

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Lessons Learned. Percutaneous thermal ablation combined with in situ granulocyte‐macrophage colony‐stimulating factor cytokine therapy was technically feasible and well tolerated.No significant clinical or immunologic responses were seen.Background.Melanoma tumor‐derived heat‐shock proteins (HSPs) and HSP‐peptide complexes can elicit protective antitumor responses. The granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) chemokine can also promote uptake and processing by professional antigen presenting cells (APCs). On this basis, we designed a pilot study of percutaneous thermal ablation as a means to induce heat‐shock protein vaccination plus GM‐CSF to determine safety and preliminary antitumor activity of this combination.Materials and Methods.This study was designed to assess overall safety of percutaneous ablation combined with GM‐CSF for unresectable, metastatic melanoma including uveal and mucosal types. All patients received heat‐shock therapy (42°C for 30 minutes), then received one of three treatments: (a) intralesional GM‐CSF (500 mcg standard dose); (b) radiofrequency ablation (RFA) + GM‐CSF; or (c) cryoablation plus GM‐CSF. The primary endpoint of the study was the induction of endogenous HSP70 and melanoma‐specific cytotoxic T lymphocytes (CTL).Results.Nine patients (three per study arm) were enrolled. No dose‐limiting toxicity was observed as specified per protocol. All patients developed progressive disease and went on to receive alternative therapy. Median overall survival (OS) was 8.2 months (95% confidence interval [CI] 2–17.2). The study was not powered to detect a difference in clinical outcome among treatment groups.Conclusion.Percutaneous thermal ablation plus GM‐CSF was well tolerated, technically feasible, and demonstrated an acceptable adverse event profile comparable to conventional RFA and cryoablation. While HSP70 was induced following therapy, the degree of HSP70 elevation was not associated with clinical outcome or induced CTL responses. While percutaneous thermal ablation plus GM‐CSF combinations including checkpoint inhibitors could be considered in future studies, the use of GM‐CSF remains experimental and for use in the context of clinical trials.

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Section: Discussionmentioning

confidence: 99%

Endogenous Heat-Shock Protein Induction with or Without Radiofrequency Ablation or Cryoablation in Patients with Stage IV Melanoma

et al. 2017

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“… 17 Patients undergoing surgical resection of late-appearing metastatic melanoma to the liver also have improved disease-free survival compared with untreated patients. 18 , 19 …”

Section: Managementmentioning

confidence: 99%

Head and neck melanoma (excluding ocular melanoma): United Kingdom National Multidisciplinary Guidelines

Ahmed

Kelly

2016

J. Laryngol. Otol.

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This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the United Kingdom. This paper provides consensus recommendations on the management of melanomas arising in the skin and mucosa of the head and neck region on the basis of current evidence.Recommendations• At-risk individuals should be warned about the correlation between ultraviolet radiation (UVR) exposure and skin cancer, and should be given advice on UVR protection. (R)• Dermatoscopy can aid in the diagnosis of cutaneous melanoma. (R)• Histological examination after biopsy is essential to confirm the diagnosis and the tumour thickness. (G)• Excisional biopsy is method of choice. (G)• Staging investigations can be performed for both regional and distant disease. (R)• Scanning (computed tomography (CT) and/or magnetic resonance imaging) is recommended for patients with high-risk melanoma. (G)• Patients with signs or symptoms of disease relapse should be investigated by imaging. (R)• Imaging of the brain should be performed in patients who have stage IV disease. (G)• Patients with melanoma of unknown primary should be thoroughly examined and investigated for a potential primary source. (R)• Primary cutaneous invasive melanoma should be excised with a surgical margin of at least 1 cm. (G)• The maximum recommended excision margin is 3 cm. (R)• The actual margin of excision depends upon the depth of the melanoma and its anatomical site. (G)• Ultrasound-guided fine needle aspiration (FNA) or core biopsy of suspected lymphadenopathy is more accurate than ‘blind’ biopsy. (R)• Open biopsy should only be performed if FNA or core biopsy is inadequate or equivocal. (R)• Prior to lymph node dissection, staging by CT scan should be carried out. (R)• If parotid disease is present without neck involvement, both parotidectomy and neck dissection should ideally be performed. (R)• There is no role for elective lymph node dissection. (R)• Sentinel lymph node biopsy (SLNB) can be considered in stage IB and above by specialist skin cancer multidisciplinary teams. (G)• Patients should be made aware that SLNB is a staging procedure, and should understand that it has, as yet, no proven therapeutic value. (R)• All patients with cutaneous melanoma should have their original tumour checked for BRAF gene status, and their subsequent targeted biological therapy based on this. (R)• Patients who develop brain metastases should be considered for stereotactic radio-surgery. (R)

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“…Patients in the ablation group were more likely to have extrahepatic disease and to have received systemic chemotherapy prior to intervention. 123 The presence of extrahepatic disease was a negative prognostic factor in those who underwent resection. In conclusion, thermal ablation may be considered an appropriate alternative or adjunct to surgery that can enable more patients to benefit from local therapy while sparing the surrounding liver parenchyma in a disease that has very limited systemic treatment options.…”

Section: Thermal Ablation Of Metastatic For Uveal Melanomamentioning

confidence: 98%

Metastatic Liver Disease: Indications for Locoregional Therapy and Supporting Data

Shamimi-Noori

Gonsalves

Shaw

2017

Semin intervent Radiol

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Metastatic liver disease is a major cause of cancer-related morbidity and mortality. Surgical resection is considered the only curative treatment, yet only a minority is eligible. Patients who present with unresectable disease are treated with systemic agents and/or locoregional therapies. The latter include thermal ablation and catheter-based transarterial interventions. Thermal ablation is reserved for those with limited tumor burden. It is used to downstage the disease to enable curative surgical resection, as an adjunct to surgery, or in select patients it is potentially curative. Transarterial therapies are indicated in those with more diffuse disease. The goals of care are to palliate symptoms and prolong survival. The indications and supporting data for thermal ablation and transarterial interventions are reviewed, technical and tumor factors that need to be considered prior to intervention are outlined, and finally several cases are presented.

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Liver resection and ablation for metastatic melanoma: A single center experience

Cited by 23 publications

References 42 publications

Endogenous Heat-Shock Protein Induction with or Without Radiofrequency Ablation or Cryoablation in Patients with Stage IV Melanoma

Endogenous Heat-Shock Protein Induction with or Without Radiofrequency Ablation or Cryoablation in Patients with Stage IV Melanoma

Head and neck melanoma (excluding ocular melanoma): United Kingdom National Multidisciplinary Guidelines

Metastatic Liver Disease: Indications for Locoregional Therapy and Supporting Data

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