Isolated hepatic perfusion with high-dose melphalan for the treatment of uveal melanoma metastases confined to the liver

Abstract

Uveal melanoma is the most common primary intraocular tumour in adults. After treatment of the primary tumour, up to 50% of patients will ultimately develop metastases. Treatment options for metastases are limited. When uveal melanoma metastases are confined to the liver, isolated hepatic perfusion (IHP) could be a treatment option. Herein, we report the results of a small group of patients with uveal melanoma metastases of the liver treated with IHP. Eight patients with uveal melanoma metastases confined to the liver underwent IHP with high-dose melphalan (200 mg) for 1 h. Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria and tumour response was assessed according to World Health Organization criteria. The tumour response rate (complete or partial remission) was 50%. The median time to progression was 6.7 months (range, 1.7-16.9 months). The overall median survival was 9.9 months (range, 4.7-34.6 months), with a 1 year survival of 50% and a 2 year survival of 37.5%. Three patients experienced grade 3-4 hepatotoxicity which was transient within 3 months. Although only a small group of patients has been treated and evaluated so far, IHP is a treatment option for uveal melanoma metastases confined to the liver which can result in tumour responses and may lead to survival benefits in a selective group of patients.

Effect of hyperthermia and chemotherapeutic agents on TRAIL‐induced cell death in human colon cancer cells

“…Alexander et al [2000a,b] yielded promising results with IHP for liver metastases from uveal melanoma showing a response rate of 62% and a median survival of up to 12 months. After IHP treatment for liver metastases from ocular melanoma, Noter and his colleagues also reported a response rate of 50% and an overall median survival of 9.9 months with a 1-year survival of 50% and a 2-year survival of 37.5% after IHP [Noter et al, 2004].…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Isolated hepatic perfusion (IHP) using melphalan (± TNF alpha) has most frequently been performed [559,560,567,568]. These studies include only small patient groups (up to 29 patients).…”

Treatment of liver metastases of colorectal cancer

“…These data indicate that IHP for the treatment of non-resectable colorectal liver metastases can result in a considerable survival benefit. IHP with melphalan has been mainly applied for the treatment of colorectal liver metastases, but promising results have also been achieved using IHP for liver metastases from uveal melanoma [60,70,75].…”