Melanoma liver metastasis is usually fatal, and although it is only diagnosed in 10% to 20% of patients with stage IV melanoma, the majority of patients with hepatic metastases as their initial site of metastatic disease will usually have poor prognosis with a short median overall survival (OS) of 4 to 6 months.
The optimal treatment for advanced melanoma continues to evolve. While traditional treatment methods have yet to be shown to alter outcomes, over the last two decades surgical techniques alongside more effective systemic therapies have improved, and according to a recent review from a team of oncologists from The John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA., patients should consider complete surgical treatment of melanoma liver metastases, as it significantly improves survival over medical treatment alone.
“Ideal candidates are those who have slow growth of their tumors due to either the natural growth rate of the tumor or positive effects of medical therapy, and those whose disease can be entirely removed or ablated,” said Dr. Mark Faries, MD, FACS, director of the melanoma research program at the John Wayne Cancer Institute in Santa Monica, California. “We’ve been proponents of metastasectomy for a long time and wanted to know how our patients who had been treated surgically for liver metastases had done,” he added.
The team of researchers searched among the medical records of 1,078 patients treated for melanoma liver metastasis in their institution since 1991, noting that 58 (5.4%) patients had received surgical therapy (resection with or without ablation). Median and 5-year OS were 8 months and 6.6%, respectively, for 1,016 nonsurgical patients vs 24.8 months and 30%, respectively, for surgical patients. Furthermore, median OS was similar among patients undergoing ablation (with or without resection) relative to those undergoing surgery alone.
The researchers came to conclude that patients who underwent surgical therapy experienced significant improved survival when compared to those receiving only medical therapy. What they also observed was that patients whose disease stabilized through medical therapy had a favorable disease outcome, independent of the number or size of their metastasis.
New and improved systemic therapies in melanoma will increase the number of patients eligible for surgical intervention, rendering this combination of treatments feasible whenever possible.
“One of the take-home messages of the study is that surgery still can play a role in the treatment of patients with metastatic melanoma, even in the era of more effective medical therapies. In fact, there may be an increasing role, particularly among patients who have had a response or disease stabilization on systemic treatment,” Dr. Faries told Medscape Medical News by Megan Brooks in an article entitled, “Surgery for Melanoma Liver Mets Can Prolong Survival.”
This study was published in the Journal of the American College of Surgeons and was funded by the National Cancer Institute, the Dr. Miriam & Sheldon G. Adelson Medical Research Foundation, the Borstein Family Foundation, the California Oncology Research Institute, and the John Wayne Cancer Institute Auxiliary.