Initial Experience with Transarterial Chemoembolization in Metastatic Cutaneous Melanoma Patients with Hepatic Progression on Immune Checkpoint Inhibitors

OBJECTIVES: To assess the safety and efficacy of performing degradable starch microspheres transarterial chemoembolization (DSM-TACE) in metastatic melanoma (MM) patients with progressive liver metastases following immune checkpoint inhibitors (ICI) treatment. MATERIAL AND METHODS: This case series evaluates 10 adult patients with MM who exhibited hepatic progression after an initial response to ICI therapy and underwent DSM-TACE without discontinuation of systemic checkpoint inhibitor therapy from January 2023 to September 2024. Tumor response was assessed using RECIST 1.1 criteria. The primary outcome measure of the study was the best overall response rate. Secondary outcome measures included local tumor control, progression-free survival, and overall survival. Adverse events were monitored and recorded. RESULTS: Ten melanoma patients (median age: 69.5 years; six females) who underwent DSM-TACE due to hepatic progression following an initial response to ICI therapy were included for safety analysis. Imaging data were unavailable for two patients, who were therefore excluded from further analyses. Best overall response rate was 87.5% (CR in two patients, PR in five patients, and SD in one patient). All treated lesions displayed sustained local tumor control throughout the follow-up. Six patients (75%) experienced the occurrence of new intra- or extrahepatic metastases. The median PFS was 8.5 months. Median OS was 12 months. Severe or life-threatening (grade 3-4) AEs associated with the combined treatment were reported in 40% (4/10-pseudoaneurysm at the puncture side, immune-related pancreatitis, anthracnosis, and colitis). Cocnclusion. Incorporating locoregional therapies, such as DSM-TACE, in patients with liver metastases from cutaneous melanoma undergoing ICI treatment is feasible, safe, and effective in achieving local disease control, potentially extending PFS and OS.