CONTEXT
toxicity, uveal melanoma liver metastases, melanoma, ORR, hepatic progression-free survival
LIVER METASTASES, MELANOMA, UVEAL MELANOMA, ADVERSE EVENTS, CUTANEOUS MELANOMA, METASTATIC UVEAL MELANOMA


Does isolated hepatic perfusion improve outcomes in previously untreated patients with liver metastases from uveal melanoma?
In this randomized controlled multicenter phase III trial, 93 patients were randomly assigned to either isolated hepatic perfusion or a control group. In an intention-to-treat analysis, both the overall response rate and progression-free survival were significantly and substantially improved, favoring isolated hepatic perfusion over the control arm.
While overall survival data are not presented, the benefit and toxicity associated with isolated hepatic perfusion for metastatic uveal melanoma are quantified, which will be useful both now and for future studies of therapy for this rare form of melanoma.**Relevance section written by In contrast to cutaneous melanoma, immune checkpoint inhibition (ICI) has been of only limited benefit in patients with uveal melanoma, with the combination of ipilimumab and nivolumab showing an overall response rate (ORR) of 10%-18% and an uncertain impact on survival.For patients with isolated liver metastases, several locoregional liver treatment strategies have been investigated. A retrospective analysis of highly selected patients undergoing surgery and achieving an R0 resection reported a median survival of 27 months.Isolated hepatic perfusion (IHP) with melphalan is a regional treatment where the liver is completely isolated from the systemic circulation to allow hepatic perfusion with high concentrations of chemotherapy, with minimal systemic exposure.In this randomized phase III trial, we compared IHP with the investigator's choice of therapy as first-line treatment in patients with isolated uveal melanoma liver metastases. In this preplanned analysis, we report the end points of ORR, hepatic progression-free survival (hPFS), progression-free survival (PFS), and safety in terms of serious adverse events (SAEs).