Percutaneous Isolated Hepatic Perfusion as a Treatment for Isolated Hepatic Metastases of Uveal Melanoma: Patient Outcome and Safety in a Multi-centre Study

Abstract

PIHP with Melphalan proved to be a relatively safe, minimal-invasive and repeatable treatment for patients with non-resectable hepatic metastases of uveal melanoma.

Safety of Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Liver Metastases from Ocular Melanoma Using the Delcath Systems’ Second-Generation Hemofiltration System: A Prospective Non-randomized Phase II Trial

“…Thromboembolic events have been reported before [ 1 , 11 , 12 ]. In our study, two patients were diagnosed with symptomatic pulmonary emboli on the first and 17 th day after M-PHP.…”

“…Bone marrow suppression results from the inability of hemofiltration cartridges to extract all melphalan, resulting in a limited amount of chemotherapeutics that reaches the systemic circulation. Reported percentages of hematologic events after M-PHP vary from 15 to 100% for anemia, 43–86% for neutropenia and 29–98% for thrombocytopenia [ 1 , 4 , 8 – 12 ].…”

“…Although survival results are still pending, it is of clinical relevance to share the results on safety and toxicity in advance. The aim of this paper was to report all safety and toxicity results and compare these with historical data from studies on M-PHP using the first-generation filter [ 1 , 6 , 8 , 11 , 12 ]. Our data on the efficacy of M-PHP with the GEN 2 filter will be reported separately.…”

Hepatic artery infusion of melphalan in patients with liver metastases from ocular melanoma

“…IHP with melphalan has emerged as a viable treatment option for ocular melanoma, with up to 70% of patients demonstrating treatment response and median overall survival extending from 10 to 24 months . Minimally invasive percutaneous approaches to hepatic perfusion have also been developed to minimize perioperative morbidity with encouraging results . Percutaneous hepatic perfusion (PHP) utilizes percutaneously placed catheters to achieve vascular control of the liver and deliver the drug to the isolated liver in a similar fashion to the open approach while sparing the morbidity associated with a laparotomy and portal dissection.…”

“…8 Isolated hepatic perfusion (IHP) is a surgical procedure that allows for complete isolation of the liver to allow administration of high doses of chemotherapy to be delivered directly to liver metastases while limiting systemic toxicity. 9 Numerous studies have evaluated IHP with the drug melphalan for ocular melanoma with encouraging results [10][11][12][13][14][15][16][17][18][19] Unfortunately, this is a complex procedure associated with significant morbidity and potential for liver toxicity. As a result, a number of patients are not candidates for the procedure due to existing hepatic dysfunction or large volume of disease, leaving them with few treatment options.…”