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Annals of Oncology Advance Access originally published online on February 9, 2006
Annals of Oncology 2006 17(4):578-583; doi:10.1093/annonc/mdl009
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© 2006 European Society for Medical Oncology

Intra-arterial hepatic fotemustine for the treatment of liver metastases from uveal melanoma: experience in 101 patients

S. Peters1,{dagger}, V. Voelter1,{dagger}, L. Zografos2, S. Pampallona3, R. Popescu1,{ddagger}, M. Gillet4, W. Bosshard1, G. Fiorentini5, M. Lotem6, R. Weitzen7, U. Keilholz8, Y. Humblet9, S. Piperno-Neumann10, R. Stupp1 and S. Leyvraz1,*

1 Centre Pluridisciplinaire d'Oncologie and 4 Département de Chirurgie, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland; 2 Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland; 3 ForMed, Evolène, Switzerland; 5 Ospedale Generale San Giuseppe, Empoli, Italy; 6 Sharett Institute of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel; 7 Sheba Medical Center, Tel Hashomer, Israel; 8 Medizinische Klinik II, Benjamin Franklin Hospital of the Free University, Berlin, Germany; 9 Centre du Cancer, St Luc University Hospital, Brussels, Belgium; 10 Institut Curie, Paris, France

* Correspondence to: Dr S. Leyvraz, Multidisciplinary Oncology Center, University of Lausanne Hospitals (CHUV), 46, rue du Bugnon, 1011 Lausanne, Switzerland. Tel: +41-21-314-0149; Fax: +41-21-314-0181; E-mail: Serge.Leyvraz{at}hospvd.ch

Background: Exclusive liver metastases occur in up to 40% of patients with uveal melanoma associated with a median survival of 2–7 months. Single agent response rates with commonly available chemotherapy are below 10%. We have investigated the use of fotemustine via direct intra-arterial hepatic (i.a.h.) administration in patients with uveal melanoma metastases.

Patients and methods: A total of 101 patients from seven centers were treated with i.a.h. fotemustine, administered intra-arterially weekly for a 4-week induction period, and then as a maintenance treatment every 3 weeks until disease progression, unacceptable toxicity or patient refusal.

Results: A median of eight fotemustine infusions per patient were delivered (range 1–26). Catheter related complications occurred in 23% of patients; however, this required treatment discontinuation in only 10% of the patients. The overall response rate was 36% with a median overall survival of 15 months and a 2-year survival rate of 29%. LDH, time between diagnosis and treatment start and gender were significant predictors of survival.

Conclusions: Locoregional treatment with fotemustine is well tolerated and seems to improve outcome of this poor prognosis patient population. Median survival rates are among the longest reported and one-third of the patients are still alive at 2 years.

Key words: fotemustine, intra-arterial hepatic chemotherapy, uveal melanoma


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