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Melanoma

Melanoma Poster Presentations 1

P39: Hyperthermic Isolated Limb Perfusion in the Era of Effective Systemic Immunotherapy

Thursday, March 21, 2024
10:07am – 10:13am ET
Location: C110
Introduction: Regional therapy remains a component of the treatment algorithm for unresectable in–transit (IT) melanoma. Parallel with the rise of systemic therapy as the preferred treatment modality for advanced melanoma, there is increased interest in determining whether immunotherapy (IO) can augment regional therapies, including hyperthermic isolated limb perfusion (HILP). Our aim was to investigate whether the perioperative administration of IO with HILP (HILPi) would improve patient outcomes.


Methods: We performed a retrospective review of a prospectively maintained database of patients with melanoma who underwent HILP between 2009-2023. In August 2014, we began utilizing FDA approved IO in combination with HILP in a preplanned “sandwich” approach (HILPi). Overall survival (OS) was estimated using the Kaplan Meier method. Additional endpoints include complete response (CR) rates, progression free survival (PFS) and distant metastasis free survival (DMFS), and are reported as cumulative incidence, with death as a competing risk.  All associations were assessed using a Cox model.


Results: 51 met inclusion criteria (38 HILP, 13 HILPi). Of the 38 HILP patients, 9 previously failed or did not tolerate IO treatment prior to HILP (not in preplanned “sandwich” approach). Mean age at time of HILP was 60.5 years. 51% of patients were female. Median follow-up was 7.5 years. 43 patients had a partial or complete response (cumulative incidence at 2 years of 83%) with 39 having a CR (cumulative incidence at 2 years of 75%). 18 of 39 patients with a CR later experienced an infield recurrence (cumulative incidence at 2 years of 42%). HILPi was associated with improved PFS on univariate analysis (UVA) (HR=0.4, p=0.018), which was retained after controlling for nodal disease at diagnosis, age, and sex. Distant metastasis developed in 30 patients (cumulative incidence at 2 years of 36%). HILPi was associated with decreased DMFS when controlling for nodal disease at diagnosis (p=0.041, HR=0.4). Previous receipt of IO prior to HILP was not associated with worse OS, PFS or DMFS (p >0.05). 5-year OS was estimated at 43% for HILP and 83% for HILPi. Undergoing HILPi had an approximately 70% lower risk of death on UVA (HR=0.29, p = 0.045).


Conclusions: HILPi was associated with improved PFS and DMFS vs HILP alone on multivariate analysis, when controlling for stage III disease at diagnosis. HILP appears to retain efficacy in the modern era for patients previously treated with IO and consideration should be given to combining HILP with systemic IO in patients with unresectable IT melanoma.

Learning Objectives:

  • Upon completion, participant will be able to better understand the utility of hyperthermic isolated limb perfusion in the era of improved systemic immunotherapy.
  • Upon completion, participant will be able to better understand treatment algorithms for in transit melanoma.
  • Upon completion, participant will be able to describe the efficacy of undergoing combined immunotherapy with hyperthermic isolated limb perfusion for in-transit melanoma.