Peters S, Voelter V, Zografos L, Pampallona S, Popescu R, Gillet M, Bosshard W, Fiorentini G, Lotem M, Weitzen R, Keilholz U, Humblet Y, Piperno-Neumann S, Stupp R, Leyvraz S
Centre Pluridisciplinaire d'Oncologie and Département de Chirurgie, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland.
Ann Oncol. 2006 Apr;17(4):578-83. doi: 10.1093/annonc/mdl009. Epub 2006 Feb 9.
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.
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.
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.
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.
高达40%的葡萄膜黑色素瘤患者会出现单纯肝转移，其平均生存期为2至7个月。常用化疗药物的单药有效率低于10%。我们研究了通过肝动脉内直接注射福莫司汀治疗葡萄膜黑色素瘤转移患者的疗效。
来自七个中心的101例患者接受了肝动脉内注射福莫司汀治疗，每周动脉内给药一次，共4周诱导期，之后每3周进行一次维持治疗，直至疾病进展、出现不可接受的毒性反应或患者拒绝治疗。
每位患者平均接受了8次福莫司汀输注（范围为1至26次）。23%的患者出现了与导管相关的并发症；然而，只有10%的患者因此需要停止治疗。总有效率为36%，平均总生存期为15个月，2年生存率为29%。乳酸脱氢酶、诊断与治疗开始之间的时间间隔以及性别是生存的显著预测因素。
福莫司汀局部区域治疗耐受性良好，似乎可改善这类预后较差患者群体的治疗结果。平均生存期是所报道的最长者之一，三分之一的患者在2年后仍然存活。
