Isolated Limb Infusion for Melanoma

Isolated limb infusion (ILI) using melphalan and dactinomycin (actinomycin D) was developed as a simplified and minimally invasive alternative to the traditional, more invasive, and elaborative isolated limb perfusion (ILP) to treat unresectable metastatic melanoma confined to the limb. An increasing number of centers around the world have reported their results using the procedure. Reports from different centers have shown that the procedure is safe, with mild-to-moderate regional toxicity, and results in satisfactory response rates. When comparing ILI and ILP, it must be borne in mind that ILI is often performed in significantly older patients and in patients with higher stages of disease, which decreases the likelihood of a favorable response. Even in this era of effective systemic therapies for metastatic melanoma, ILI is still worthwhile and a relatively straightforward, single-treatment option to treat locally recurrent or in-transit metastatic melanoma involving a limb. Due to its minimally invasive nature, ILI is an ideal platform to test new drugs and drug combinations. Potential exists to further improve ILI response rates when combined with novel therapies.