Multinational retrospective comparison of first-line options for melanoma in-transit metastases

Isolated limb infusion and perfusion (ILI/ILP) has been a mainstay treatment for unresectable melanoma in-transit metastases (ITM), but increased use of immune checkpoint inhibitors (ICIs) and intralesional talimogene laherparepvec (TVEC) introduced several different management options. A retrospective study at 12 centers in 3 countries compared first-line ILI/ILP (n=356), ICIs (n=125), and TVEC (n=70) for melanoma ITM. Using ICI as the reference category, TVEC had the highest odds of a complete response (OR 1.96; p=0.029) and longer local progression-free survival (HR 0.40; p=0.003), while ILI/ILP had shorter local PFS (1.72; p=0.012), PFS (1.79; p<0.001), distant metastasis-free survival (1.75; p=0.014), melanoma-specific survival (2.29; p=0.004), and overall survival (1.82; p=0.009). The authors conclude that TVEC as first-line therapy for unresectable melanoma ITM was associated with superior complete response rates and local PFS.