Isolated limb perfusion in Merkel cell carcinoma offers a high rate of complete response and moderately durable local-regional control: Systematic review and institutional experience

Merkelcell.org Summary

Hyperthermic isolated limb perfusion (HILP) is a treatment to target cancer that affects only one arm or leg. This procedure involves isolating the limb (either an arm or a leg) from the rest of the body’s circulation. Then, doctors heat chemotherapy drugs to a higher temperature and circulate them through the limb’s blood vessels. The heat and high concentration of the drugs aim to kill cancer cells more effectively while minimizing side effects to the rest of the body. A study done using HILP in fourteen MCC patients found that 12 of them had all their MCC gone after treatment (complete response), 1 had some of it gone (partial response), and 1 had no change in their MCC. However, within 6 months after HILP, 3 of the patients had their MCC come back close to where their original cancer was (local/regional recurrence), and 5 patients had their MCC come back in another part of the body (distant recurrence). Half (7 out of 14) of the patients had no recurrence within 6 months of HILP. HILP may be safe and help control MCC in one area for some patients, but the risk of the MCC coming back elsewhere may still be high using this technique.

Abstract

Introduction: Hyperthermic isolated limb perfusion (HILP) has an established role in the management of melanoma, but its role for Merkel cell carcinoma (MCC) is less well defined.

Methods: Retrospective review of our institutional experience with HILP for MCC was conducted (2009-2015). Literature search was performed through 04/2015 and 10 studies met inclusion criteria.

Results: Four patients underwent HILP for MCC at our institution. There were no major complications and complete response was achieved in all patients. Early metastatic recurrence developed in two patients. The remaining two had no evidence of disease at last follow-up (36 months) or death (39 months). Systematic review identified an additional 12 pts that underwent HILP for MCC, for a total of 16 cases. Median age was 73 [IQR 69-78] years and 56% were men. Of the patients with reported follow-up, 12 (86%) had complete response, 1 had stable disease, and 1 partial response. Four patients developed local-regional recurrence and six distant metastases, all within 6 months. Overall median follow-up time was 15 [7-36] months.

Conclusion: Among a highly selective group of patients, regional perfusion for MCC is safe and has a high complete response rate. HILP is an acceptable therapeutic modality for obtaining durable loco-regional control but early distant metastatic disease remains a significant cause of mortality. J. Surg. Oncol. 2016;114:187-192. © 2016 Wiley Periodicals, Inc.