A pilot study of trans arterial chemo-embolization (TACE) with drug eluting beads irinotecan (IRI) preloaded (DEBI) for liver metastases (LM) from uveal melanoma (UM): An Italian National Study

Abstract

20010 Background: Exclusive LM occur in up to 40% of patients with UM associated with a median survival of 2–5 months; surgery and chemotherapy have poor results. Experimental efficacy of IRI on B16 melanoma cells was reported and studies with oral IRI showed interesting activity in melanoma patients. TACE seems effective in palliation of LM from different tumours. Methods: Between February 2006 and November 2007, nine patients with LM from UM (F/M = 4/5, median age 44 yrs, liver replacement (LR) 25% = 2 cases, 50% = 2 cases, 75% = 5), treated with surgery (3 cases) and chemo-immunotherapy (9) were enrolled into a pilot trial of TACE with DEBI. One patient had early death and two had early progression during staging and were not treated. TACE with DEBI (adopting beads with diameter of 300–500 μ in the first triplet of patients and 100–300 μ in the second triplet) preloaded with 200 mg of IRI was delivered every 4 weeks for 2 folds. Computed Tomography was performed 24h before and after treatment, then every month till progression. Before treatment intra-arterial lidocaine and from day 0 to 4 analgesic medications, antibiotics and intravenously hydration were administered Results: Six patients received 12 cycles (2 each patient). Right upper quadrant pain (RUQP) grade 2 short lasting, fever grade 2 lasting 3 days (range 2–7) and increases of liver enzymes grade 2–3 were reported by all patients. After 30 days, a reduction of 75% of the lesional contrast enhancement was observed in the first triplet of patients. A complete disappearance of enhancement was observed in the second triplet. Three patients with LR = 75% died at 64 days, 120, 155. Two patients with LR = 25% are alive at 188 and 431 days respectively. One with LR = 50% is alive at 147 days Conclusions: TACE with DEBI is feasible and safe in patients with LM from UM. Fever, RUQP, increases of liver enzymes are the side effects. Responses seem related to beads diameter. Survival is related to liver substitution. No significant financial relationships to disclose.