Southampton would be the better choice, According to the NICE guidelines ocular metastatic melanoma should be treated by a specialist with an interest in that disease. Professor Lorigan the professor in charge of the melanoma treatments in Christies has repeatedly told me that "he does not do ocular melanoma". The requitrements are a team that has a specific MDT that meets to specifically discuss OM this happens in Southampton and lIVERPOOL. Southampton has done this for many years Liverpool was talking of setting up a virtual MDT when i last spoke with them 2 years ago. There are some excellent doctors in Liverpool and Southampton and Christies, but it is having people focussed that is important. Lorrigan has also told OcuMel UK that repeatedly too. There are probably less than 300 metastatic cases in UK each year so really if you want to see someone who knows something you have to go to a specific tean dedicated. Like a general vet can treat a horse but if its a race horse with a tendon you go to an equine specialist. The outcome may or may not be altered but you will be offered more chances by the equine specialist. The interpretation of scans and prognosis will be better from a Vet that is more used to dealing with horeses. Although your 35 year old pony will be adequately treated by a general vet - horses for courses. However your mother in her early 60s is realtively young and should be considered high value. unless there are a lot of co morbidities making aggressive treatment unsustainable.
I was a Gp I got liver mets in 2009. I have had the treatment that was available. There is no proven effective treatment but targetted liver therapy and immune stimulating drugs have helped me live a more or less normal life for the last 5+ years. I was 50 when the mets were diaganosed.
I disagree with Micahel I do not think chemo embolisation will be of any benefit for such small widespread disease. I had Sirtex (internal radiaiont with Ytrrium beeds ) that cleared 22+ lesions all under 1 cm from my liver in 2011. I had had IPi just prior to that.
I do not know the social circumstance but basically you have not time to waste. Dr Stedman in Southampton is the doctor that has done most SIRTEX to OM in the UK technically he is brilliant and a really good doctor + a nice person which is more than a patient can usually hope for! Dr Jonathan Evans also does sirtex in Liverpool also focussed on OM- he was also on the guidelines developement group.
I travelled from Doncaster to southampton for immune therapies it was very arduous I would advice your mother transfers to Southampton.
Currently the fashion is to treat with lvier perfusion using a device made by Delcath. That was only available in the US when I had my first liver treatments. I could not afford it as it involves at least 1 night in ITU often more. It is a repeatable procedure in Holland and the US they do 3 or 4 treatment s here we only do 2. I do not think the results have been any better or worse than SIRTEX some respond some dont.
Sirtex costs about £30 000 in UK it is a one off procedure it wiil work or not depends on the abiliy of blood vessels to recieve the angio entered radiation and the susceptablitly to radiation of the tumour. If you can afford or your mother can get on and get it quick with either the 2 guys I mentioned.
Delcath is not currently availble at the moment people diagnosed in feb are waiting for dates in May.
The only trial is a mek inhibitor + AKT inhibitor it has a quite a lot of side effects. I looked at it in Germany a couple of years ago and they advised I was too well. If you opt for othre treatment first one is excluded from this trail It is not a proven therapy should do well theroetically but the small molecule inhibitors have failed to live up to their promises. Adding about 8 - 12 weeks stable disease but no overalll survival benefit . Most patients will need a dose reduction or 2 due to intolerable side effects. the odd thing is progression seems really rapid once it starts folliwing small molecule inhibitors. There is no point in Dacarbazine.It has never been trailed in OM even in skin melanoma it is no longer used by those in the know.
Immune therapies work is about 5% that is very good odds for OM (Dacarbazine has a response rate of less than 3% and some say less than 1% MD Anderson in Texas- they reviewed all their use of Dacarbaziine and came up with these figures. Ipilimumab is availbe to OM NICE guide lines on first line use so cannot be refused. It is as I say only about 5% response rate but those where it works can have a prolonged remission or stable disease- I remained disease free for 2 years for only 4 infusions combined with the SIRTEX in 2011. I did get side effects but one recovers once the infusions finish.
My husbands family are all Vets in Northern Ireland and his cousin is a prof in Glasgow in VEterinary medicine. I had horses in Yorkshire and made good use of equine clinics! Om in horses is different I think they have less hetrogenecity than we have and the same with dogs so their disease seems more treatable.
The ~Spire Southampoton does SIRTEX privately . Sadly the technique is highly operator dependent and if Dr STedman or Dr Evans at Liverpool are fully booked I would recommend Dr Nutting in Co USA he has treated the OM mets with SIRTEX or Theraspheres for nearly 10 years. If control of the liver is gained one might get at least a year of respite. before disease returns.
I will PM you Little white envelope top RH corner.
Om had no NHS funidng for SIRTEX its the wrong sort of cancer.
I do not understand the logic of chemo embolisation of widespread small lesions. Only a few can be treated by this method and those untreated will grow and enhance the growth of new lesions. If any one can explain why treating a few lesions in the liver is of benefit I would be really intetrested. I think there have been inadequate trails and it is an easy procedure so it became the fashion. Mainly led by Dr Sato. Dr Vogel nearly always does it before any other procedure the logci being that it sensitizes ther cells for further treatment. This may well be true in Colon cancer however I do not see any evidence of this in OM.
However metastatic OM is poorly understood and there are some patients who will do well - like me - with treatment - probably the 5% who respond to ipi. So it may be something individual to that patient and immune system and may explain the anecdotal report of patients who have responded to Dacarbazine- they would have done better than average any way. HOwever my longevity 5.5 years still running 5k daily suggests that something made a change in my diseaese.
Having no treatment is an option and some patients do well for up to a year to 18 months however they again are probably people like me.
After Ipi there is pembrolizumab which is an immune therapy but one has to have failed IPi first. There is a trial at MOunt Vernon combining nivolimumab and ipi which would be a possiblity after the liver is treated.
Are you sure there is no disease else where have they checked?