Transhepatic Therapies for Metastatic Uveal Melanoma

Abstract

Despite successful treatment of the primary tumor, uveal melanoma has a propensity to metastasize to the liver. Prognosis is poor due to the very aggressive nature of these tumors. Because systemic therapies are relatively ineffective and patient survival correlates to disease control in the liver, locoregional therapies provide a means of prolonging survival. We review various techniques including chemoembolization, immunoembolization, radioembolization, arterial fotemustine infusion, and hepatic perfusion for the treatment of liver metastases from uveal melanoma.

Reduction of Nodular Growth Pattern of Metastatic Uveal Melanoma after Radioembolization of Hepatic Metastases

“…Locoregional treatment of metastatic uveal melanoma is indicated when there is lack of response to systemic chemotherapy, the disease burden is limited to the liver, or there is urgent need for local control [6]. Transarterial embolization of the liver utilizing a variety of embolic materials, including cytotoxic and chemotherapeutic drugs, drug-eluting beads, immunologic stimulants, and radioactive microspheres, is an established and effective therapy for some patients with unresectable hepatic metastases [6].…”

“…Transarterial embolization of the liver utilizing a variety of embolic materials, including cytotoxic and chemotherapeutic drugs, drug-eluting beads, immunologic stimulants, and radioactive microspheres, is an established and effective therapy for some patients with unresectable hepatic metastases [6]. Chemoembolization utilizing cisplatin-based therapies was among the earliest techniques and has been in use for nearly 3 decades, with reported response rates approaching 40% in some studies [19,20].…”

“…Chemoembolization utilizing cisplatin-based therapies was among the earliest techniques and has been in use for nearly 3 decades, with reported response rates approaching 40% in some studies [19,20]. A newer locoregional technique is percutaneous hepatic perfusion (Hepatic CHEMOSAT® Delivery System; Delcath Systems, Inc., New York, N.Y., USA), which allows for high-dose chemosaturation of the liver through isolation of the liver blood supply and the use of a veno-veno bypass with extracorporeal filtration of the toxin-containing blood [6]. Our patient underwent 90 Y brachytherapy radioembolization of both hepatic lobes.…”

“…With no effective systemic chemotherapy available [5], embolization is an important locoregional method of palliation for metastatic disease [6]. Herein, we report a case of worsening hepatic sinusoidal infiltrative metastatic uveal melanoma in the setting of regressing radioembolized nodular liver metastases.…”

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

“…• Provide expertise and support for combined therapies in patients with metastatic disease with transarterial chemotherapies drug eluted beads (Venturini et al, 2012), chemoembolisation (Huppert et al, 2010), chemoperfusion, chemosaturation or radioembolisation (for the latter with the nuclear medicine physician) (Eschelman et al, 2013), or ablative therapies for liver and lung metastases (Shashank et al, 2014;de Baère et al, 2015).…”