Advertisement

Predictors of Overall and Progression-Free Survival in Patients with Ocular Melanoma Metastatic to the Liver Undergoing Y90 Radioembolization

  • Alexa O. Levey
  • Mohammad Elsayed
  • David H. Lawson
  • Robert M. Ermentrout
  • Ragini R. Kudchadkar
  • Zachary L. Bercu
  • Melinda L. Yushak
  • Janice Newsome
  • Nima KokabiEmail author
Clinical Investigation Interventional Oncology
  • 8 Downloads
Part of the following topical collections:
  1. Interventional Oncology

Abstract

Purpose

To investigate predictors of overall survival (OS) and progression-free survival (PFS) in patients with ocular melanoma metastatic to the liver undergoing yttrium-90 (Y90) radioembolization, including the effect of concurrent immunotherapy.

Methods

An IRB-approved retrospective review of 24 patients with ocular melanoma metastatic to the liver who underwent Y-90 treatment between June 2003 and January 2018 was performed. Data regarding patients’ performance status at the time of Y90, intra-/extrahepatic tumor burden, and treatment response were evaluated. RECIST was used to determine objective tumor response. Kaplan–Meier analysis was used to calculate OS and PFS from the first Y90 therapy. Log-rank analysis was used to determine predictors of prolonged OS and PFS.

Results

Median OS from primary diagnosis and diagnosis of liver metastases was 66 months (mo) and 26.3 mo, respectively. Median OS for those who received immunotherapy within 3 months of undergoing Y90 was prolonged at 26.0 mo versus 9.5 mo for others (p = 0.014). Median OS for patients with an ECOG performance status of 0 was prolonged at 26 mo versus 5.5 mo for others (p = 0.003). Median hepatic PFS was prolonged in patients treated with Y-90 on concurrent immunotherapy at 10.3 mo versus 2.7 mo for TARE only (p = 0.002). Patients with an ECOG performance status of 0 had prolonged PFS (p = 0.002).

Conclusions

Concurrent immunotherapy and an ECOG performance status of 0 at the time of Y90 therapy appear to be predictors of prolonged OS and PFS in patients with ocular melanoma metastatic to the liver.

Keywords

Uveal melanoma Ocular melanoma Liver metastasis Immunotherapy Radioembolization 

Notes

Author Contributions

Nima Kokabi, preceptor, conceived and designed the analysis. Alexa Levey and Mohammad Elsayed collected the data and performed the analysis. Alexa Levey wrote the paper. All authors discussed the results and contributed to the final manuscript.

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this study, no formal consent is required. The study was approved by IRB.

Informed Consent

This study has obtained IRB approval (indicate the relevant board) and the need for informed consent was waived. For this type of study, consent for publication is not required.

References

  1. 1.
    Komatsubara KM, Carvajal RD. Immunotherapy for the treatment of uveal melanoma: current status and emerging therapies. Curr Oncol Rep. 2017;19(7):45.CrossRefGoogle Scholar
  2. 2.
    Schelhorn J, Richly H, Ruhlmann M, Lauenstein TC, Theysohn JM. A single-center experience in radioembolization as salvage therapy of hepatic metastases of uveal melanoma. Acta Radiol Open. 2015;4(4):2047981615570417.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Gonsalves CF, Eschelman DJ, Sullivan KL, Anne PR, Doyle L, Sato T. Radioembolization as salvage therapy for hepatic metastasis of uveal melanoma: a single-institution experience. AJR Am J Roentgenol. 2011;196(2):468–73.CrossRefGoogle Scholar
  4. 4.
    Klingenstein A, Haug AR, Zech CJ, Schaller UC. Radioembolization as locoregional therapy of hepatic metastases in uveal melanoma patients. Cardiovasc Interv Radiol. 2013;36(1):158–65.CrossRefGoogle Scholar
  5. 5.
    Chattopadhyay C, Kim DW, Gombos DS, et al. Uveal melanoma: from diagnosis to treatment and the science in between. Cancer. 2016;122(15):2299–312.CrossRefGoogle Scholar
  6. 6.
    Page DB, Postow MA, Callahan MK, Wolchok JD. Checkpoint modulation in melanoma: an update on ipilimumab and future directions. Curr Oncol Rep. 2013;15(5):500–8.CrossRefGoogle Scholar
  7. 7.
    Gupta S, Bedikian AY, Ahrar J, et al. Hepatic artery chemoembolization in patients with ocular melanoma metastatic to the liver: response, survival, and prognostic factors. Am J Clin Oncol. 2010;33(5):474–80.CrossRefGoogle Scholar
  8. 8.
    Sato T. Locoregional management of hepatic metastasis from primary uveal melanoma. Semin Oncol. 2010;37(2):127–38.CrossRefGoogle Scholar
  9. 9.
    Xing M, Prajapati HJ, Dhanasekaran R, et al. Selective internal yttrium-90 radioembolization therapy (90Y-SIRT) versus best supportive care in patients with unresectable metastatic melanoma to the liver refractory to systemic therapy: safety and efficacy cohort study. Am J Clin Oncol. 2017;40(1):27–34.CrossRefGoogle Scholar
  10. 10.
    Zheng J, Irani Z, Lawrence D, Flaherty K, Arellano RS. Combined effects of yttrium-90 transarterial radioembolization around immunotherapy for hepatic metastases from uveal melanoma: a preliminary retrospective case series. J Vasc Interv Radiol. 2018;29(10):1369–75.CrossRefGoogle Scholar
  11. 11.
    Valsecchi ME, Terai M, Eschelman DJ, et al. Double-blinded, randomized phase II study using embolization with or without granulocyte-macrophage colony-stimulating factor in uveal melanoma with hepatic metastases. J Vasc Interv Radiol. 2015;26(4):523–32.CrossRefGoogle Scholar
  12. 12.
    Lane AM, Kim IK, Gragoudas ES. Survival rates in patients after treatment for metastasis from uveal melanoma. JAMA Ophthalmol. 2018;136(9):981–6.CrossRefGoogle Scholar
  13. 13.
    Gil-Alzugaray et al. (2017). SIR-spheres Y-90 resin microspheres (yttrium-90 microspheres). Retrieved from https://www.sirtex.com/media/155126/ssl-us-13.pdf. Accessed 1 Mar 2019.
  14. 14.
    Atkins MB, Lotze MT, Dutcher JP, et al. High-dose recombinant interleukin 2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993. J Clin Oncol. 1999;17(7):2105–16.CrossRefGoogle Scholar
  15. 15.
    Coldwell D, Sangro B, Salem R, Wasan H, Kennedy A. Radioembolization in the treatment of unresectable liver tumors: experience across a range of primary cancers. Am J Clin Oncol. 2012;35(2):167–77.CrossRefGoogle Scholar
  16. 16.
    Braat MN, van Erpecum KJ, Zonnenberg BA, van den Bosch MA, Lam MG. Radioembolization-induced liver disease: a systematic review. Eur J Gastroenterol Hepatol. 2017;29(2):144–52.CrossRefGoogle Scholar
  17. 17.
    Reits EA, Hodge JW, Herberts CA, et al. Radiation modulates the peptide repertoire, enhances MHC class I expression, and induces successful antitumor immunotherapy. J Exp Med. 2006;203(5):1259–71.CrossRefGoogle Scholar
  18. 18.
    Gameiro SR, Jammeh ML, Wattenberg MM, Tsang KY, Ferrone S, Hodge JW. Radiation-induced immunogenic modulation of tumor enhances antigen processing and calreticulin exposure, resulting in enhanced T-cell killing. Oncotarget. 2014;5(2):403–16.CrossRefGoogle Scholar
  19. 19.
    Deng L, Liang H, Burnette B, et al. Irradiation and anti-PD-L1 treatment synergistically promote antitumor immunity in mice. J Clin Investig. 2014;124(2):687–95.CrossRefGoogle Scholar
  20. 20.
    Dewan MZ, Galloway AE, Kawashima N, et al. Fractionated but not single-dose radiotherapy induces an immune-mediated abscopal effect when combined with anti-CTLA-4 antibody. Clin Cancer Res. 2009;15(17):5379–88.CrossRefGoogle Scholar
  21. 21.
    Itchins M, Ascierto PA, Menzies AM, et al. A multireferral centre retrospective cohort analysis on the experience in treatment of metastatic uveal melanoma and utilization of sequential liver-directed treatment and immunotherapy. Melanoma Res. 2017;27(3):243–50.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Alexa O. Levey
    • 1
  • Mohammad Elsayed
    • 1
  • David H. Lawson
    • 2
  • Robert M. Ermentrout
    • 1
  • Ragini R. Kudchadkar
    • 2
  • Zachary L. Bercu
    • 1
  • Melinda L. Yushak
    • 2
  • Janice Newsome
    • 1
  • Nima Kokabi
    • 1
    Email author
  1. 1.Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided MedicineEmory University School of MedicineAtlantaUSA
  2. 2.Department of Hematology and OncologyEmory University School of MedicineAtlantaUSA

Personalised recommendations