Transarterial Infusion of Pembrolizumab Plus TACE for Liver Metastases of Melanoma

BACKGROUND: Melanoma hepatic metastases demonstrate limited responsiveness to conventional systemic immune checkpoint blockade therapy, primarily attributed to the hepatic microenvironment's immunosuppressive characteristics. To our knowledge, this is the first reported case describing selective hepatic arterial infusion of pembrolizumab immediately followed by transarterial chemoembolization (TACE) for liver-dominant melanoma metastases after progression on systemic therapy. CASE PRESENTATION: This case report describes an alternative therapeutic strategy employed for a 61-year-old female patient with hepatic metastases secondary to chemotherapy-refractory uveal melanoma. Therapeutic intervention consisted of selective hepatic arterial pembrolizumab infusion immediately succeeded by TACE utilizing carboplatin, mitomycin, and idarubicin combined with lipiodol emulsion. Treatment cycles were administered at eight-week intervals for two sessions. Radiological assessment 3 months post-treatment demonstrated a complete response with absence of detectable hepatic malignancy. CONCLUSION: This clinical experience represents the initial documentation of sequential intraarterial pembrolizumab followed by TACE in chemotherapy-resistant melanoma hepatic metastases. While a complete radiologic response was observed, conclusions regarding efficacy cannot be drawn from a single case. This approach appears feasible and warrants further study in well-designed clinical investigations.