Treatment strategies with electrochemotherapy for limb in-transit melanoma: real-world outcomes from a european, retrospective, cohort study
Campana, L. G. Tauceri, F. Bártolo, J. Calabrese, S. Odili, J. Carrara, G. Farricha, V. Piazzalunga, D. Bottyán, K. Bisarya, K.
Campana, L. G.
Tauceri, F.
Bártolo, J.
Calabrese, S.
Odili, J.
Carrara, G.
Farricha, V.
Piazzalunga, D.
Bottyán, K.
Bisarya, K.
Citations
Altmetric:
Abstract
BACKGROUND: This study analysed treatment strategies with electrochemotherapy (ECT) in melanoma with limb in-transit metastases (ITM). METHODS: We audited AJCC v.8 stage IIIB-IIID patients treated across 22 centres (2006-2020) within the International Network for Sharing Practices of ECT (InspECT). RESULTS: 452 patients were included, 58 % pre-treated (93 % had lower limb ITM, 44 % had =10 metastases [median size 1.5 cm]. Treatment strategies included first-line ECT (n = 145, 32 %), ECT with concurrent locoregional/systemic treatment (n = 163, 36 %), and salvage ECT (n = 144, 32 %). The objective response rate was 63 % (complete response [CR], 24 %), increasing to 74 % (CR, 39 %) following retreatment (median two ECT, range 1-8). CR rate in treatment-naïve and pre-treated patients was 50 % vs 32 % (p < 0.001). Bleomycin de-escalation was associated with lower CR (p = 0.004). Small tumour number and size, hexagonal electrode, retreatment, and post-ECT skin ulceration predicted response in multivariable analysis. At a median follow-up of 61 months, local and locoregional recurrence occurred in 55 % and 81 % of patients. Median local progression-free, new lesions-free, and regional recurrence-free survival were 32.9, 6.9, and 7.7 months. Grade-3 toxicity was 15 %. Concurrent treatment and CR correlated with improved regional control and survival. Concomitant checkpoint inhibition did not impact toxicity or survival outcomes. The median overall survival was 5.7 years. CONCLUSIONS: Among patients with low-burden limb-only ITM, standard-dose bleomycin ECT results in durable local response. Treatment naivety, low tumour volume, hexagonal electrode application, retreatment, and post-ECT ulceration predict response. CR and concurrent treatment correlate with improved regional control and survival outcomes. Combination with checkpoint inhibitors is safe but lacks conclusive support.
Authors
Campana, L. G.
Tauceri, F.
Bártolo, J.
Calabrese, S.
Odili, J.
Carrara, G.
Farricha, V.
Piazzalunga, D.
Bottyán, K.
Bisarya, K.
Mascherini, M.
Clover, J. A.
Sestini, S.
Bošnjak, M.
Kis, E.
Fantini, F.
Covarelli, P.
Brizio, M.
Sayed, L.
Cabula, C.
Careri, R.
Fabrizio, T.
Eisendle, K.
MacKenzie Ross, A.
Schepler, H.
Borgognoni, L.
Sersa, G.
Valpione, Sara
Tauceri, F.
Bártolo, J.
Calabrese, S.
Odili, J.
Carrara, G.
Farricha, V.
Piazzalunga, D.
Bottyán, K.
Bisarya, K.
Mascherini, M.
Clover, J. A.
Sestini, S.
Bošnjak, M.
Kis, E.
Fantini, F.
Covarelli, P.
Brizio, M.
Sayed, L.
Cabula, C.
Careri, R.
Fabrizio, T.
Eisendle, K.
MacKenzie Ross, A.
Schepler, H.
Borgognoni, L.
Sersa, G.
Valpione, Sara
Description
Date
2024
Publisher
Collections
Keywords
Type
Article
Citation
Campana LG, Tauceri F, Bártolo J, Calabrese S, Odili J, Carrara G, et al. Treatment strategies with electrochemotherapy for limb in-transit melanoma: Real-world outcomes from a European, retrospective, cohort study. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2024 Oct 5:108740. PubMed PMID: 39448361. Epub 2024/10/25. eng.