Hepatic chemosaturation with melphalan in patients with primary or secondary liver tumors with or without extrahepatic tumor manifestation

Abstract

Background

Hepatic chemosaturation by isolated percutaneous liver perfusion (CS-PHP) with melphalan controls hepatic tumor growth. However, optimal treatment frequency and the prognostic relevance of extrahepatic tumor manifestation remain unclear. We analyzed response and tolerability of repeated treatment in regular cycles of CS-PHP.

Materials and methods

CS-PHP was administered to patients with primary or secondary liver tumors. Overall survival (OS) and hepatic disease control rate (hDCR) were assessed retrospectively by modified RECIST after at least one response assessment, and toxicity by Common Terminology Criteria for Adverse Events v4.03.

Results

A total of 97 CS-PHP treatments were carried out in 33 patients between 2016 and 2023. Patients had unresectable intrahepatic metastases of uveal melanoma (n = 19), intrahepatic cholangiocarcinoma (n = 8), hepatocellular carcinoma (n = 2), ciliary body melanoma (n = 1), acinar cell carcinoma (n = 1), pancreatic cancer (n = 1) or tonsil cancer (n = 1). CS-PHP was carried out seven times in 1 patient, six times in 5, five times in 3, four times in 2, three times in 4, twice in 7 and once in 11 patients. The median OS was 65 weeks (standard error 13.6, 95% confidence interval 38.2-91.5 weeks). hDCR was 91% (30 of 33 patients) at last observation time point. Extrahepatic tumor manifestations were not associated with OS. CS-PHP was well tolerated. Grade III or IV pancytopenia occurred in two patients.

Conclusion

CS-PHP induced hepatic disease control in the majority of patients. Extrahepatic tumor manifestation had no significant impact on OS. The relevance of CS-PHP as long-term treatment needs to be validated in future studies.