First-Line Selective Internal Radiation Therapy in Patient with Uveal Melanoma Liver Metastases

Abstract

Survival of patients with uveal melanoma liver metastases is strongly correlated with disease control in the liver. Unfortunately, there are no standardized treatments for this chemo-resistant disease. Selective Internal Radiation Therapy (SIRT) has been tested as salvage therapy but no data exist about its use as first-line therapy. The purpose of this study was to investigate the safety and efficacy of SIRT used as first-line therapy in patients with uveal melanoma metastatic to the liver. Methods: This retrospective analysis of a prospectively collected cohort included 22 patients treated with first-line SIRT. Biochemical and clinical toxicities were recorded. Tumor response included European Association for the Study of Liver Disease (EASL) criteria. Predictive factors of survival were analyzed by uni-/multivariate analysis. Overall survival was calculated using the Kaplan-Meier method with the log-rank test. Results: Grade 3-4 biological and clinical toxicities occurred in 24% of patients (for both). According to EASL, disease control at 6 months after SIRT was achieved in 15 (52%) of the 29 SIRT and was predictive of survival. Median overall survival from the first SIRT was 18 months [95% confidence interval (95%CI), 8-28]. At the time of the analysis, 5 patients (23%) were still alive. In multivariate analysis, largest lesion size [1.22 hazard ratio (HR); 95%CI, 0.98-1.53], liver tumor volume [1.002 HR; 95%CI, 1.0004-1.003], subsequent systemic [0.04 HR; 95%CI, 0.006-0.24] and liver-directed locoregional therapies [0.204 HR; 95%CI, 0.04-0.94] were predictive of survival. Conclusion: First-line SIRT is safe and demonstrated promising outcomes in patients with uveal melanoma liver metastases. Subsequent systemic and liver-directed locoregional therapies ameliorated survival, highlighting the potential for improved outcomes with combinatorial approaches. The results of this study suggest that prospective trials using first-line SIRT should be considered.