E320: Isolated Limb Infusion as First, Second, or Third-Line Therapy for Melanoma with In-Transit Metastasis

ePoster Abstract Author(s)

Aleena Boby, B.A. (she/her/hers)

Medical Student
University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL
Tampa, Florida, United States

Submitter(s)

Aleena Boby, B.A. (she/her/hers)

Medical Student
University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL
Tampa, Florida, United States

Author(s)

Aleena Boby, B.A. (she/her/hers)

Medical Student
University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL
Tampa, Florida, United States
MD

Michelle M. Dugan, MD

Research Fellow
Cutaneous Oncology Department, Moffitt Cancer Center, Tampa, FL, United States
HG

Helana Ghali, BS

Medical Student
University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL, United States
Shaliz Aflatooni, BS (she/her/hers)

Medical Student
University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL
Tampa, Florida, United States
Danielle K. DePalo, MD (she/her/hers)

Resident
Department of General Surgery, University of Massachusetts Chan Medical School, Boston, MA, United States
WF

Wenyi Fan, MSPH

Biostatistician
Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa FL, United States
Jonathan S. Zager, MD

Cutaneous Surgeon
H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida, United States

Introduction:

Up to 10% of patients with high risk early-stage melanoma will develop in-transit metastases (ITM), which appear as tumor nodules in the subcutaneous or cutaneous tissues between the primary site and the nearest draining nodal basin. Isolated limb infusion (ILI) is a well-established regional therapy for ITM, but the ideal sequencing of ILI in relation to systemic and intralesional therapies has not been defined. The goal of this study is to evaluate the response and survival rates after receiving ILI as either first-line, second-line, or third-line or later therapy, for melanoma with ITM.

Methods:

A retrospective review was conducted, including patients with melanoma with ITM who underwent an ILI from 2002-2023.

Results:

A total of 130 patients were identified, including 61% female, with a median age of 71 (31-89) years, and 83% with lower extremity disease. Median follow-up time was 37.5 months. ILI was given as first-line therapy in 80% (n=104), second-line therapy in 15% (n=19), and third-line or later therapy in 5.4% (n=7). First-line therapies patients failed were immunotherapy (n=7), radiation (n=6), chemotherapy (n=2), ILP (n=2), and intralesional therapy (n=2). Second-line treatments patients failed were immunotherapy (n=2), chemotherapy (n=2), ILP (n=1), radiation (n=1), and intralesional therapy (n=1).

Overall response rate (ORR) and complete response (CR) rate for ILI as any line of therapy were 74% and 41%, respectively. ORR for ILI as first, second, or third-line or later therapy were 78%, 63%, and 57%, respectively. CR rates for ILI as first, second, or third-line or later therapy were 42%, 37%, and 43%, respectively. There were no statistically significant differences in ORR between therapy lines. ORR was 75% for lower extremity disease and 72% for upper extremity disease. CR rate was 41% for lower extremity disease and 43% for upper extremity disease.

There were no significant differences in overall survival, disease free survival, or progression free survival (PFS), based on sequencing of ILI. Median overall PFS for ILI as first, second, or third-line or later therapy were 6.9, 5.4, and 18 months, respectively.

Conclusions:

Patients generally responded well to ILI, whether they had received previous therapies or not. Although sample size limited statistical significance, a 21% improvement in ORR for patients who received ILI as first-line therapy versus third-line therapy is clinically relevant. This study demonstrates that ILI serves as an effective treatment option for patients with melanoma with ITM and can be used to salvage patients who have failed previous therapies.

Learning Objectives:

Upon completion, participant will be able to identify survival outcomes after an isolated limb infusion for patients with limb threatening melanomas.
Upon completion, participant will be able to compare how disease progression differs among patients based on response to isolated limb infusion.
Upon completion, participant will understand how sequencing of isolated limb infusion as a treatment impacts disease progression and survival outcomes.