TREATMENT OF OCULAR MELANOMA METASTATIC TO THE LIVER BY HEPATIC ARTERIAL CHEMOTHERAPY

Purpose: Ocular melanoma is characterized by a high rate of liver meta stases and is associated with a median survival time less than 5 month s. There is no standard treatment available. Treatment strategies have , without success, relied on the experience with metastatic cutaneous melanoma. The only effective treatment is chemoembolization using cisp latin and polyvinyl sponge, which has never become accepted on a large scale. The objective of the study was to establish prospectively the efficacy and toxicity of hepatic intraarterial fotemustine, a third-ge neration nitrosourea, in patients with liver metastases from ocular me lanoma. Patients and Methods: Thirty-one patients were subjected to la parotomy to place a totally implantable catheter into the hepatic arte ry and received fotemustine 100 mg/m(2) as a 4-hour infusion, first on ce a week for four times and then, after a 5-week rest period, every 3 weeks until progression or toxicity, Cox regression models were used to assess the prognostic role of patient survival characteristics. Res ults: Objective responses were observed in 12 of 30 assessable patient s (40%; 95% confidence interval, 22% to 59%), The median duration of r esponse was 11 months and the median overall survival time, 14 months. Lactate dehydrogenase (LDH) appeared to be the strongest prognostic f actor for survival. Toxicity was minimal and treatment could be admini stered on an outpatient basis. Conclusion: The results of hepatic arte rial chemotherapy with fotemustine produced a high response rate and s urvival similar to chemoembolization therapy. It involves no major tox icity and preserves the quality of life. To assess further its effecti veness, a randomized study to compare hepatic intraarterial versus int ravenous chemotherapy is being planned. (C) 1997 by American Society o f Clinical Oncology.