1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) chemoembolization (TACE) for treatment of bulky uveal melanoma (UM) hepatic metastases

Abstract

<h3>Purpose</h3> To determine if BCNU TACE is effective and safe for patients who present with bulky UM liver metastases. <h3>Materials and Methods</h3> Fifty treatment naïve patients (mean age 59.1 years [range 30-88]; 19 women and 31 men) presenting with ≥50% tumor burden (TB), ECOG 0-2 performance status and adequate liver/renal function were treated over a 6-year period. Lobar TACE was performed using BCNU (200mg) dissolved in ethiodized oil followed by gelfoam embolization. Best radiologic response (RECIST) was determined using CT/MRI every 3-5 weeks after treatment of all hepatic tumors. Overall (OS) and progression-free survivals (PFS) were compared to TB and LDH levels using Kaplan-Meier analysis. TB was classified as 50-59%, 60-75% and >75%. LDH levels were divided into ≤500 and >500. CTCAE v4.0 was used to assess treatment toxicity. <h3>Results</h3> Fifty patients had 271 procedures. Best radiologic response included PR in 3 patients, SD in 33 patients, and PD in 12 patients. Two patients had no follow-up imaging. Median OS was 7.1 months (range 1.2 - 32.3) and PFS was 5.0 months (range 1.1 - 32.3) for all 50 patients. Eleven patients (22%) survived >12 months (range 12.2-32.3) post TACE with 1 patient alive at follow-up. Forty patients died from liver metastases, 8 from extrahepatic disease and 1from an unrelated cause. TB and LDH levels had no statistically significant effect on OS (p=0.4755 and p=0.1358, respectively) or PFS (p=0.2015 and p=0.3391, respectively) (Table 1). Grade 3 thrombocytopenia occurred in 2 patients. Grade 3 hyperbilirubinemia (n=2) was due to PD. <h3>Conclusion</h3> BCNU TACE is a safe and effective treatment for patients presenting with bulky UM liver metastases. 22% of our patients survived >1-year following initial treatment. This is an encouraging result for patients with ≥50%TB given the aggressive nature of this disease. 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) Chemoembolization (TACE) for Treatment of Bulky Uveal Melanoma (UM) Hepatic Metastases