Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review

Abstract

The Hepatic CHEMOSAT® Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic metastases from solid organ malignancies. This system is used to perform chemosaturation percutaneous hepatic perfusion (CS-PHP), a procedure in which a high dose of the chemotherapeutic agent melphalan is delivered directly to the liver while limiting systemic exposure. In a clinical trial program, CS-PHP with melphalan significantly improved hepatic progression-free survival in patients with unresectable hepatic metastases from ocular or cutaneous melanoma. Clinically meaningful hepatic responses were also observed in patients with hepatocellular carcinoma or neuroendocrine tumors. Furthermore, the results of published studies and case reports demonstrated that CS-PHP with melphalan resulted in favorable tumor response rates in a range of tumor histologies (ocular or cutaneous melanoma, colorectal cancer, and hepatobiliary tumors). Analyses of the safety profile of CS-PHP revealed that the most common adverse effects were hematologic events (thrombocytopenia, anemia, and neutropenia), which were clinically manageable. Taken together, these findings indicate that CS-PHP is a promising locoregional therapy for patients with primary and secondary liver tumors and has a acceptable safety profile. Funding: Delcath Systems Inc., New York, NY, USA.

Percutaneous isolated hepatic perfusion (chemosaturation) with melphalan following right hemihepatectomy in patients with cholangiocarcinoma and metastatic uveal melanoma: peri- and post-interventional adverse events and therapy response compared to a matched group without prior liver surgery

“…All procedures were performed in an angio suite under general anaesthesia due to the lengths of the intervention (mean 164 ± 52 min) and due to the haemodynamic changes, which are common with the transient inferior vena cava (IVC) occlusion and blood filtration [ 15 ]. In CS-PHP, an appropriate sheath is inserted through the femoral artery and a catheter is placed in the hepatic artery to provide a chemoperfusion with high dose melphalan of the supplied liver parenchyma.…”

“…The double balloon catheter is equipped with multiple side holes. An extracorporeal pump extracts the melphalan-enriched blood into a dedicated filtration system (Delcath system's second-generation hemofiltration system), which separates melphalan from the venous blood with a filtration rate of up to 93-96% [15][16][17]. The extracorporeal circuit is completed by the return of the blood via a sheath in the jugular vein.…”

Uveal melanoma: Towards a molecular understanding

“…Fifty to seventy-five percent of metastatic UM patients responded to IHP with the chemotherapeutic agent melphalan. The most common adverse effects were hematological eventssuch as thrombocytopenia, anemia, and neutropeniawhich were clinically manageable, indicating that IHP with melphalan could be a promising treatment for UM patients with liver metastasis (Artzner et al, 2019;Meijer et al, 2019;Vogel et al, 2017). Currently IHP is performed for established metastatic disease, but future drugs with less side-effects might allow targeted adjuvant treatment in high-risk UM patients (Olofsson et al, 2014).…”

Chemosaturation with Percutaneous Hepatic Perfusion: Outcome and Safety in Patients with Metastasized Uveal Melanoma

“…Venous blood can drain through the multiple lateral holes of the double balloon catheter. Once the correct position of the catheter is angiographically confirmed, a pump draws the venous melphalan-enriched blood into an extracorporeal filtration system, which separates up to 96 % of melphalan from the blood [13,14]. The circuit is closed by returning the filtered blood via a CVC in the jugular vein.…”