Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature

Background. Isolated limb perfusion (ILP) is a locoregional procedure indicated by the unresectable melanoma of the limbs. Its complexity and highly demanding multidisciplinary approach means that it is a technique only implemented in a few referral centers around the globe. This report aims to exam...

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Autores principales:	Lourdes Sevilla-Ortega, Lara Ferrándiz-Pulido, Natalia Palazón-Carrión, María del Carmen Álamo de la Gala, Rubén de Toro-Salas, José Garnacho-Montero, José Antonio Marcos-Rodríguez, Ana Agudo Martínez, Omar Araji-Tiliani, María Cinta Calvo-Morón, José Miguel Barquero-Aroca, Antonio Ramón Fernández-López, José María Jaime-Borrego, Juan Carlos Santos-Jiménez, David Moreno-Ramírez, Luis de la Cruz-Merino
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	malignant melanoma chemotherapy isolated limb perfusion melphalan tumor necrosis factor Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/4e330b5c99654faaa261eba27e256008
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spelling	oai:doaj.org-article:4e330b5c99654faaa261eba27e2560082021-11-11T15:33:41ZRole of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature10.3390/cancers132154852072-6694https://doaj.org/article/4e330b5c99654faaa261eba27e2560082021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5485https://doaj.org/toc/2072-6694Background. Isolated limb perfusion (ILP) is a locoregional procedure indicated by the unresectable melanoma of the limbs. Its complexity and highly demanding multidisciplinary approach means that it is a technique only implemented in a few referral centers around the globe. This report aims to examine its potential role in the era of targeted therapies and immunotherapy by conducting a systematic review of the literature on ILP. Methods. PubMed, Embase and Cochrane Library were searched. The eligibility criteria included publications from 2000–2020 providing valid data o effectiveness, survival or toxicity. Studies in which the perfusion methodology was not clearly described, letters to the editor, non-systematic reviews and studies that applied outdated clinical guidelines were excluded. To rule out studies of a low methodological quality and assess the risk of bias, the following aspects were also required: a detailed description of the applied ILP regimen, the clinical context, follow-up periods, analyzed clinical endpoints, and the number of analyzed ILPs. The disagreements were resolved by consensus. The results are presented in tables and figures. Results. Twenty-seven studies including 2637 ILPs were selected. The median overall response rate was 85%, with a median complete response rate of 58.5%. The median overall survival was 38 months, with a 5-year overall survival of 35%. The toxicity was generally mild according to Wieberdink toxicity criteria. Discussion. ILP still offer a high efficacy in selected patients. The main limitation of our review is the heterogeneity and age of most of the articles, as well as the absence of clinical trials comparing ILP with other procedures, making it difficult to transfer its results to the current era. Conclusions. ILP is still an effective and safe procedure for selected patients with unresectable melanoma of the limbs. In the era of targeted therapies and immunotherapy, ILP remains an acceptable and reasonable palliative treatment alternative, especially to avoid limb amputations. The ongoing clinical trials combining systemic therapies and ILP will provide more valuable information in the future to clarify the potential synergism of both strategies.Lourdes Sevilla-OrtegaLara Ferrándiz-PulidoNatalia Palazón-CarriónMaría del Carmen Álamo de la GalaRubén de Toro-SalasJosé Garnacho-MonteroJosé Antonio Marcos-RodríguezAna Agudo MartínezOmar Araji-TilianiMaría Cinta Calvo-MorónJosé Miguel Barquero-ArocaAntonio Ramón Fernández-LópezJosé María Jaime-BorregoJuan Carlos Santos-JiménezDavid Moreno-RamírezLuis de la Cruz-MerinoMDPI AGarticlemalignant melanomachemotherapyisolated limb perfusionmelphalantumor necrosis factorNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5485, p 5485 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	malignant melanoma chemotherapy isolated limb perfusion melphalan tumor necrosis factor Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	malignant melanoma chemotherapy isolated limb perfusion melphalan tumor necrosis factor Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Lourdes Sevilla-Ortega Lara Ferrándiz-Pulido Natalia Palazón-Carrión María del Carmen Álamo de la Gala Rubén de Toro-Salas José Garnacho-Montero José Antonio Marcos-Rodríguez Ana Agudo Martínez Omar Araji-Tiliani María Cinta Calvo-Morón José Miguel Barquero-Aroca Antonio Ramón Fernández-López José María Jaime-Borrego Juan Carlos Santos-Jiménez David Moreno-Ramírez Luis de la Cruz-Merino Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature
description	Background. Isolated limb perfusion (ILP) is a locoregional procedure indicated by the unresectable melanoma of the limbs. Its complexity and highly demanding multidisciplinary approach means that it is a technique only implemented in a few referral centers around the globe. This report aims to examine its potential role in the era of targeted therapies and immunotherapy by conducting a systematic review of the literature on ILP. Methods. PubMed, Embase and Cochrane Library were searched. The eligibility criteria included publications from 2000–2020 providing valid data o effectiveness, survival or toxicity. Studies in which the perfusion methodology was not clearly described, letters to the editor, non-systematic reviews and studies that applied outdated clinical guidelines were excluded. To rule out studies of a low methodological quality and assess the risk of bias, the following aspects were also required: a detailed description of the applied ILP regimen, the clinical context, follow-up periods, analyzed clinical endpoints, and the number of analyzed ILPs. The disagreements were resolved by consensus. The results are presented in tables and figures. Results. Twenty-seven studies including 2637 ILPs were selected. The median overall response rate was 85%, with a median complete response rate of 58.5%. The median overall survival was 38 months, with a 5-year overall survival of 35%. The toxicity was generally mild according to Wieberdink toxicity criteria. Discussion. ILP still offer a high efficacy in selected patients. The main limitation of our review is the heterogeneity and age of most of the articles, as well as the absence of clinical trials comparing ILP with other procedures, making it difficult to transfer its results to the current era. Conclusions. ILP is still an effective and safe procedure for selected patients with unresectable melanoma of the limbs. In the era of targeted therapies and immunotherapy, ILP remains an acceptable and reasonable palliative treatment alternative, especially to avoid limb amputations. The ongoing clinical trials combining systemic therapies and ILP will provide more valuable information in the future to clarify the potential synergism of both strategies.
format	article
author	Lourdes Sevilla-Ortega Lara Ferrándiz-Pulido Natalia Palazón-Carrión María del Carmen Álamo de la Gala Rubén de Toro-Salas José Garnacho-Montero José Antonio Marcos-Rodríguez Ana Agudo Martínez Omar Araji-Tiliani María Cinta Calvo-Morón José Miguel Barquero-Aroca Antonio Ramón Fernández-López José María Jaime-Borrego Juan Carlos Santos-Jiménez David Moreno-Ramírez Luis de la Cruz-Merino
author_facet	Lourdes Sevilla-Ortega Lara Ferrándiz-Pulido Natalia Palazón-Carrión María del Carmen Álamo de la Gala Rubén de Toro-Salas José Garnacho-Montero José Antonio Marcos-Rodríguez Ana Agudo Martínez Omar Araji-Tiliani María Cinta Calvo-Morón José Miguel Barquero-Aroca Antonio Ramón Fernández-López José María Jaime-Borrego Juan Carlos Santos-Jiménez David Moreno-Ramírez Luis de la Cruz-Merino
author_sort	Lourdes Sevilla-Ortega
title	Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature
title_short	Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature
title_full	Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature
title_fullStr	Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature
title_full_unstemmed	Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature
title_sort	role of isolated limb perfusion in the era of targeted therapies and immunotherapy in melanoma. a systematic review of the literature
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/4e330b5c99654faaa261eba27e256008
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Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature

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