A Multi-Institutional Experience of Isolated Limb Infusion: Defining Response and Toxicity in the US

Beasley, Georgia M.; Caudle, Abigail S.; Petersen, Rebecca P.; McMahon, Nicole; Padussis, James C.; Mosca, Paul J.; Zager, Jonathan S.; Hochwald, Steven N.; Grobmyer, Stephen R.; Delman, Keith A.; Andtbacka, Robert H.I.; Noyes, R. Dirk; Kane, John M.; Seigler, Hilliard; Pruitt, Scott K.; Ross, Merrick I.; Tyler, Douglas S.

doi:10.1016/j.jamcollsurg.2008.12.019

Cited by 138 publications

(128 citation statements)

References 21 publications

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“…166 Melphalan is commonly used for ILI, often with actinomycin D. 167 The addition of papaverine for cutaneous vasodilation has been shown to increase response rate but also the risk of regional toxicity. 168,169 ILI is associated with lower rates of toxicity and morbidity compared with ILP, but retrospective comparisons of response and survival with ILP versus ILI have shown varying results. 168,[170][171][172][173][174] An analysis of 7 studies involving 576 patients, primarily with stage III disease and treated with melphalan/actinomycin D combination via ILI, showed an overall response rate of 73%, with complete response in 33% (range, 26%-44% across studies), partial response in 40% (33%-53%), and stable disease in 14%.…”

Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

“…168,169 ILI is associated with lower rates of toxicity and morbidity compared with ILP, but retrospective comparisons of response and survival with ILP versus ILI have shown varying results. 168,[170][171][172][173][174] An analysis of 7 studies involving 576 patients, primarily with stage III disease and treated with melphalan/actinomycin D combination via ILI, showed an overall response rate of 73%, with complete response in 33% (range, 26%-44% across studies), partial response in 40% (33%-53%), and stable disease in 14%. 167 A smaller pooled analysis of 2 additional studies (N=58), one a noncomparative phase II study (ClinicalTrials.gov identifier: NCT00004250), showed similar overall response rates for stage IIIB versus stage IIIC disease (48% vs 40%), and similar 5-year survival rates (38% vs 52%).…”

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confidence: 99%

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Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

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214

165

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OverviewIn 2016, an estimated 76,380 patients will be diagnosed with and approximately 10,130 patients will die of melanoma in the United States.1 However, these figures for new cases may represent a substantial underestimate, as many superficial and in situ melanomas treated in the outpatient setting are not reported. The incidence of melanoma continues to increase dramatically, at an overall rate of 33% for men and 23% women from 2002 to 2006.2 Melanoma is increasing in men more rapidly than any other malignancy, and in women more rapidly than any other malignancy except lung cancer. AbstractThis selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma focuses on adjuvant therapy and treatment of in-transit disease, because substantial changes were made to the recommendations for the 2016 update. Depending on the stage of the disease, options for adjuvant therapy now include biochemotherapy and highdose ipilimumab. Treatment options for in-transit disease now include intralesional injection with talimogene laherparepvec (T-VEC), a new immunotherapy. These additions prompted reassessment of the data supporting older recommended treatment options for adjuvant therapy and in-transit disease, resulting in extensive revisions to the supporting discussion sections. J Natl Compr Canc Netw 2016;14(4):450-473 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.All recommendations are category 2A unless otherwise noted.Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines ® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network ® (NCCN ® ) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Melanoma are not printed in this issue of JNCCN but can be accessed online at NCCN.org.© National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Melanoma ...

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Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

mentioning

confidence: 99%

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

Self Cite

214

165

View full text Add to dashboard Cite

show abstract

“…The response rate was significantly higher in patients >70 years than in those below 70 years (91 % vs. 78%, P<0.05). A recent study showed that the complete response rate reached 31% in 128 patients who had received ILI (80). In another study on ILP, higher CR rate (63%) was achieved, and meanwhile the 5-year survival reached 38% (81).…”

Section: Lymph Node Dissectionmentioning

confidence: 99%

Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition)

et al. 2016

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“…The less invasive regional therapy technique, ILI, has been reported to elicit a complete response in approximately one-third of patients. 19,20 The more aggressive therapy, HILP, which requires the surgical isolation of the vessels to be cannulated with higher doses of chemotherapy circulated throughout the extremity, results in complete response rates between 40% and 80%. 8,[21][22][23][24][25][26] The complete response rates in our cohort are similar to these other single-center studies, with complete responses in 30% of patients undergoing an ILI and in 44% of patients receiving an HILP.…”

Section: Commentmentioning

confidence: 99%