A pilot study of intrahepatic Yttrium-90 microsphere radioembolisation in combination with intravenous cisplatin for uveal melanoma liver-only meta...

Date 25 November 2018
Event ESMO Asia 2018 Congress
Session Mini Oral - Melanoma and Sarcoma
Topics Melanoma
Locoregional Treatment
Presenter Surein Arulananda
Citation Annals of Oncology (2018) 29 (suppl_9): ix105-ix108. 10.1093/annonc/mdy439
Authors S. Arulananda1, S. Parakh1, M. Goodwin2, M. Andrews1, J. Cebon1
  • 1Department Of Medical Oncology, Olivia Newton John Cancer & Wellness Centre, 3084 - Heidelberg/AU
  • 2Department Of Radiology, Austin Hospital, 3084 - Heidelberg/AU

Abstract

Background

Uveal melanoma is the most common primary intraocular malignancy in adults. Despite successful local therapy, almost half of all patients develop metastases, with the majority relapsing in the liver. Unlike cutaneous melanoma, there are no effective systemic treatments for metastatic uveal melanoma, with dismal response rates seen with immune checkpoint inhibitors. This prospective study was conducted to evaluate the safety and efficacy of radiosensitising chemotherapy in combination with Ytrrium-90 microspheres in patients with uveal melanoma with liver-only metastases.

Methods

This single arm, open labeled, non-randomized study enrolled 10 patients with liver-only metastatic uveal melanoma between November 2012 and January 2018 at the Austin Hospital. Eligible patients received intrahepatic yttrium-90 microspheres followed by intravenous cisplatin (20mg/m2) for five days.

Results

Ten patients were enrolled with a median follow up of 30 months (range 7 – 44). Five (50%) were female, five (50%) had an elevated LDH and one (10%) had prior anti-PD-1 therapy. The combination was well tolerated with no ≥Grade 3 toxicity observed. The liver ORR was 33% (3/9), the median PFS in the liver was 3 months (95% CI 3 - NA) and the extra-hepatic PFS was 3 months (95% CI 3 - NA). 78% (7/9) received an immune checkpoint inhibitor on disease progression, with no responses seen. The median OS was 10 months (95% CI 7 - NA).

Conclusions

The combination of cisplatin with yttrium-90 microspheres was well tolerated however it was associated with intra-hepatic disease control of relatively short duration. No responses were seen in patients treated with immune checkpoint inhibitors post radioembolisation. Translational studies are required in order to determine if locoregional therapies are capable of enhancing immune responses and thereby improving responses to immune checkpoint inhibitors.

Editorial acknowledgement

Clinical trial identification

Austin 04888.

Legal entity responsible for the study

Sirtex.

Funding

Sirtex.

Disclosure

All authors have declared no conflicts of interest.