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Percutaneous hepatic perfusion with melphalan in uveal melanoma: a safe and effective treatment modality in an orphan disease

Percutaneous hepatic perfusion with melphalan in uveal melanoma: a safe and effective treatment modality in an orphan disease
Percutaneous hepatic perfusion with melphalan in uveal melanoma: a safe and effective treatment modality in an orphan disease

BACKGROUND: Metastatic uveal melanoma (UM) carries a poor prognosis; liver is the most frequent and often solitary site of recurrence. Available systemic treatments have not improved outcomes. Melphalan percutaneous hepatic perfusion (M-PHP) allows selective intrahepatic delivery of high dose cytotoxic chemotherapy.

METHODS: Retrospective analysis of outcomes data of UM patients receiving M-PHP at two institutions was performed. Tumor response and toxicity were evaluated using RECIST 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) v4.03, respectively.

RESULTS: A total of 51 patients received 134 M-PHP procedures (median of 2 M-PHPs). 25 (49%) achieved a partial (N = 22, 43.1%) or complete hepatic response (N = 3, 5.9%). In 17 (33.3%) additional patients, the disease stabilized for at least 3 months, for a hepatic disease control rate of 82.4%. After median follow-up of 367 days, median overall progression free (PFS) and hepatic progression free survival (hPFS) was 8.1 and 9.1 months, respectively and median overall survival was 15.3 months. There were no treatment related fatalities. Non-hematologic grade 3-4 events were seen in 19 (37.5%) patients and were mainly coagulopathic (N = 8) and cardiovascular (N = 9).

CONCLUSIONS: M-PHP results in durable intrahepatic disease control and can form the basis for an integrated multimodality treatment approach in appropriately selected UM patients.

Journal Article
0022-4790
1170-1178
Karydis, Ioannis
95a2388c-7165-40e1-8b73-87234caea36d
Gangi, Alexandra
ff6a09be-4c69-499d-a516-3df6463330eb
Wheater, Matthew J
3691c3d8-8589-4693-a0dc-c6a8648cd7df
Choi, Junsung
29452e3b-f738-40ee-8181-47090e3643ca
Wilson, Iain
71af53ee-f9d5-45e1-9437-522444bd3fa4
Thomas, Kerry
fa7e5f24-4478-44dc-b7b8-aea52a1314ce
Pearce, Neil
99caea3a-6e0a-42c4-a85a-2d5a5b34bced
Takhar, Arjun
e2f77012-0993-42e6-af95-597a73b6ce45
Gupta, Sanjay
3eae7ae7-8915-4c1f-8f28-2882160b9a62
Hardman, Danielle
72c1eea6-6a65-4695-ac68-9d7fe197a9d2
Sileno, Sean
80629c4b-c8c5-47ad-8a4c-1dd9edeb9773
Stedman, Brian
180a4644-f670-4da1-84db-9d5640e4ec1d
Zager, Jonathan S
1502530f-805d-4525-88c7-1789bcbf8bba
Ottensmeier, Christian
42b8a398-baac-4843-a3d6-056225675797
Karydis, Ioannis
95a2388c-7165-40e1-8b73-87234caea36d
Gangi, Alexandra
ff6a09be-4c69-499d-a516-3df6463330eb
Wheater, Matthew J
3691c3d8-8589-4693-a0dc-c6a8648cd7df
Choi, Junsung
29452e3b-f738-40ee-8181-47090e3643ca
Wilson, Iain
71af53ee-f9d5-45e1-9437-522444bd3fa4
Thomas, Kerry
fa7e5f24-4478-44dc-b7b8-aea52a1314ce
Pearce, Neil
99caea3a-6e0a-42c4-a85a-2d5a5b34bced
Takhar, Arjun
e2f77012-0993-42e6-af95-597a73b6ce45
Gupta, Sanjay
3eae7ae7-8915-4c1f-8f28-2882160b9a62
Hardman, Danielle
72c1eea6-6a65-4695-ac68-9d7fe197a9d2
Sileno, Sean
80629c4b-c8c5-47ad-8a4c-1dd9edeb9773
Stedman, Brian
180a4644-f670-4da1-84db-9d5640e4ec1d
Zager, Jonathan S
1502530f-805d-4525-88c7-1789bcbf8bba
Ottensmeier, Christian
42b8a398-baac-4843-a3d6-056225675797

Karydis, Ioannis, Gangi, Alexandra, Wheater, Matthew J, Choi, Junsung, Wilson, Iain, Thomas, Kerry, Pearce, Neil, Takhar, Arjun, Gupta, Sanjay, Hardman, Danielle, Sileno, Sean, Stedman, Brian, Zager, Jonathan S and Ottensmeier, Christian (2018) Percutaneous hepatic perfusion with melphalan in uveal melanoma: a safe and effective treatment modality in an orphan disease. Journal of Surgical Oncology, 117 (6), 1170-1178. (doi:10.1002/jso.24956).

Record type: Article

Abstract

BACKGROUND: Metastatic uveal melanoma (UM) carries a poor prognosis; liver is the most frequent and often solitary site of recurrence. Available systemic treatments have not improved outcomes. Melphalan percutaneous hepatic perfusion (M-PHP) allows selective intrahepatic delivery of high dose cytotoxic chemotherapy.

METHODS: Retrospective analysis of outcomes data of UM patients receiving M-PHP at two institutions was performed. Tumor response and toxicity were evaluated using RECIST 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) v4.03, respectively.

RESULTS: A total of 51 patients received 134 M-PHP procedures (median of 2 M-PHPs). 25 (49%) achieved a partial (N = 22, 43.1%) or complete hepatic response (N = 3, 5.9%). In 17 (33.3%) additional patients, the disease stabilized for at least 3 months, for a hepatic disease control rate of 82.4%. After median follow-up of 367 days, median overall progression free (PFS) and hepatic progression free survival (hPFS) was 8.1 and 9.1 months, respectively and median overall survival was 15.3 months. There were no treatment related fatalities. Non-hematologic grade 3-4 events were seen in 19 (37.5%) patients and were mainly coagulopathic (N = 8) and cardiovascular (N = 9).

CONCLUSIONS: M-PHP results in durable intrahepatic disease control and can form the basis for an integrated multimodality treatment approach in appropriately selected UM patients.

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Accepted/In Press date: 18 November 2017
e-pub ahead of print date: 28 December 2017
Published date: 1 May 2018
Additional Information: © 2017 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.
Keywords: Journal Article

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Local EPrints ID: 416651
URI: https://eprints.soton.ac.uk/id/eprint/416651
ISSN: 0022-4790
PURE UUID: 1be01e4c-9f56-4a15-a2df-8b9b6c49cad9

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Date deposited: 04 Jan 2018 17:30
Last modified: 13 Mar 2019 19:02

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Contributors

Author: Ioannis Karydis
Author: Alexandra Gangi
Author: Matthew J Wheater
Author: Junsung Choi
Author: Iain Wilson
Author: Kerry Thomas
Author: Neil Pearce
Author: Arjun Takhar
Author: Sanjay Gupta
Author: Danielle Hardman
Author: Sean Sileno
Author: Brian Stedman
Author: Jonathan S Zager

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