Abstract No. 523 Locoregional therapy for liver metastases in uveal melanoma: improvements in progression-free survival and predictors of response

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Liver is the most common metastatic site in uveal melanoma, and as such, locoregional therapies play an important role in the management of these patients. The purpose of this study was to determine the relative effectiveness of different locoregional therapies for uveal melanoma liver metastases and to determine predictors of response. A single-institution, IRB-approved retrospective review of patients with uveal melanoma who underwent hepatic arterial infusion (HAI) therapy, chemoembolization, bland embolization, radioembolization, or percutaneous thermal ablation was performed. Progression-free and overall survival analysis was performed, and predictors for treatment response were determined by Cox proportional hazards. 59 patients were included in the study; 18 underwent HAI, while 41 underwent non-HAI tumor-targeted therapy (TTT), including 29 chemoembolization, 4 bland embolization, 7 thermal ablation, and 1 radioembolization patients. Progression-free survival (PFS) was significantly higher in the TTT group versus the HAI group (6 months PFS 85.7% vs 68.8%, P < 0.05). Though there was a trend towards improved overall survival (OS) in the TTT group vs the HAI group, the difference was not significant (median OS 2483 vs 724 days, P = 0.07). There was a non-significant trend toward improved survival with cisplatin versus doxorubicin chemoembolization and bland embolization. Pre-procedure LDH (P = 0.04) and neutrophil-to-lymphocyte ratio (NLR) (P = 0.02) were significant predictors of progression-free survival for patients undergoing TTT (P < 0.05), while tumor volume, tumor focality, prior chemotherapy, and time interval from primary tumor presentation to development of metastasis were not. Non-responders to LDH were noted to have significantly greater pre- and postprocedural NLR. LDH was noted to decrease after treatment but increase at the time of progression. TTT improves progression-free survival relative to HAI in patients with uveal melanoma liver metastases. Additionally, preprocedure NLR is a significant predictor of treatment response to TTT, and LDH may be an early indicator of tumor recurrence in patients who undergo TTT.