Chemosaturation with percutaneous hepatic perfusion of melphalan for liver-dominant metastatic uveal melanoma: a single center experience

Abstract

Objective: To 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 methods: This 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.

Results: Partial 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.

Conclusion: CS-PHP is an efficacious and safe treatment for patients presenting with liver-dominant metastatic uveal melanoma.

Keywords: Chemosaturation; Liver;; Ocular melanoma; percutaneous hepatic perfusion.

Fig. 1

Progression-free survival Kaplan Meier estimates. Of note: three patients received a second chemosaturation therapy without evidence of progressive disease

Fig. 2

Overall survival Kaplan Meier estimates. Of note: 15 individual patients were treated with 28 chemosaturation therapies

Fig. 3

a: Patient case. Of note, a depicts a patient with liver dominant metastatic uveal melanoma at baseline before first chemosaturation with percutaneous hepatic perfusion (CS-PHP) treatment. The patient responded with partial remission 3 month after first CS-PHP procedure (b). Sustained hepatic tumor control was achieved for 30 months by five treatments with CS-PHP, while extrahepatic progressive disease was noted (c). After a sixth CS-PHP application and 35 months after first CS-PHP therapy, progression was diagnosed intra- and extrahepatically (d). b: Patient case. Of note, (a) T2 weighted images of a patient with liver dominant metastatic uveal melanoma at baseline before first chemosaturation with percutaneous hepatic perfusion (CS-PHP) treatment. The patient responded with partial remission 3 month after first CS-PHP procedure (b). Sustained hepatic tumor control was achieved for 13 months (c). Progression was diagnosed intrahepatically after 17 months, and patient was scheduled for a new CS-PHP (d)