Metastatic melanoma to the liver: A contemporary and comprehensive review of surgical, systemic, and regional therapeutic options

Sanjiv S. Agarwala, Alexander M.M. Eggermont, Steven O'Day, Jonathan S. Zager

Research output: Contribution to journalReview articlepeer-review

81 Citations (Scopus)

Abstract

Effective management of hepatic metastases from ocular and cutaneous melanoma remains a major therapeutic challenge. Treatment options include hepatic resection, hepatic intra-arterial (HIA) chemotherapy, chemoembolization, and hepatic perfusions. Evaluating the efficacy of these interventions is limited by the retrospective nature of most of the data, although controlled phase 3 studies are starting to emerge. Studies of hepatic resection are strongly suggestive of a survival benefit following surgery in selected patients. Effective systemic agents for metastatic cutaneous melanoma are available and supported by randomized controlled phase 3 trials. In contrast, no active systemic treatment has yet been identified for metastatic ocular melanoma. HIA and intravenous delivery of fotemustine have been compared in a randomized phase 3 trial in patients with unresectable metastases from melanoma, but no differences between the 2 approaches were observed. Hepatic arterial chemoembolization appears only to be moderately effective according to uncontrolled studies; targeting patients with less liver involvement may improve outcomes. A recent phase 3 study showed a significant improvement in hepatic progression-free survival with percutaneous hepatic perfusion compared with best alternative care in patients with metastatic melanoma; however, the overall survival analysis was confounded by crossover of control patients to active treatment. In conclusion, hepatic resection offers the possibility of long-term survival in carefully selected patients with liver-limited metastases from melanoma. In patients with unresectable cutaneous melanoma, effective systemic therapy is the best treatment option. For patients with unresectable ocular melanoma, regional treatments are likely to assume a greater role until effective systemic treatments are identified. Cancer 2014;120:781-789.

Original languageEnglish
Pages (from-to)781-789
Number of pages9
JournalCancer
Volume120
Issue number6
DOIs
Publication statusPublished - 15 Mar 2014
Externally publishedYes

Keywords

  • chemoembolization
  • cutaneous melanoma
  • hepatic intra-arterial infusion
  • hepatic metastases
  • ocular melanoma
  • perfusion
  • review
  • surgery
  • systemic therapy

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