Abstract
ObjectiveTo investigate the outcome and safety data of chemosaturation with percutaneous hepatic perfusion (CS-PHP) of melphalan in patients with liver-dominant metastatic uveal melanoma.Material and methodsThis is a HIPAA compliant, IRB approved, retrospective study. A total of 28 CS-PHPs were performed in 16 individual patients (six men and ten women, median age 63.1 years [range 49.1 to 78.7 years], one to six CS-PHP procedures per patient) for treatment of liver-dominant metastatic uveal melanoma between June, 2015 and December, 2018. All patients received cross-sectional imaging at baseline and during follow-up. CS-PHP was performed with the Hepatic CHEMOSAT® Delivery System (Delcath Systems, Inc., NY, USA) facilitating extracorporeal filtration of hepatic blood for melphalan removal. Ideal body weight-adjusted melphalan doses were administered into the hepatic arteries. Serious adverse events (SAE), progression-free survival based on response criteria in solid tumors, and overall survival were noted. Survival data were analyzed using Kaplan-Meier estimates.ResultsPartial response after first CS-PHP was observed in nine patients (60%), stable disease in five patients (33%) and progressive disease in one patient (7%). Median overall survival was 27.4 months (95% CI 4.1 to 35.4 month) after first CS-PHP. Median progression-free survival was 11.1 months after first CS-PHP (95% CI 4.9 to 23.6 months). SAEs were observed in the majority of patients with most SAEs limited to grades one and two. Thirteen SAEs of grades three and four were observed in seven individual patients. No grade five SAE was observed.ConclusionCS-PHP is an efficacious and safe treatment for patients presenting with liver-dominant metastatic uveal melanoma.
Highlights
Partial response after first chemosaturation with percutaneous hepatic perfusion (CS-PHP) was observed in nine patients (60%), stable disease in five patients (33%) and progressive disease in one patient (7%)
CS-PHP is an efficacious and safe treatment for patients presenting with liver-dominant metastatic uveal melanoma
An analysis of 435 patients included in the Collaborative Ocular Melanoma Study found that 93% of patients had liver metastases at the time of death [7]
Summary
A total of 28 CS-PHPs were performed in 16 individual patients (six men and ten women, median age 63.1 years [range 49.1 to 78.7 years], one to six CS-PHP procedures per patient) for treatment of liver-dominant metastatic uveal melanoma between June, 2015 and December, 2018. All patients received cross-sectional imaging at baseline and during follow-up. Survival data were analyzed using Kaplan-Meier estimates This is a HIPAA compliant, IRB approved, retrospective study with waiver of informed consent. The median interval between baseline assessment and CS-PHP was eight days (interquartile range 1 to 14 days). Follow-up cross-sectional imaging consisted of liver MRI and whole-body CT for all patients. The median interval between CS-PHP and follow-up imaging was 81 days (interquartile range 50 to 94 days)
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