110. Percutaneous hepatic perfusion with melphalan in treating unresectable liver metastases of colorectal cancer and uveal melanoma: A phase I/II trial

14549 Background: To determine the maximum-tolerated dose (MTD) and to evaluate the efficacy and tolerability of combination chemotherapy of irinotecan (CPT-11), UFT and leucovorin (LV) with hepatic arterial infusion (HAI) in colorectal cancer patients with unresectable liver metastases. Methods: Patients who had unresectable liver metastases from colorectal cancer were treated concurrently with intravenous CPT-11 on day1 of each 14-day treatment cycle with dose escalation, with orally UFT and LV on day 1–7 of each cycle, and with HAI of 5-FU on day 8–14 of each cycle. The primary objective of this phase I study was to determine the MTD of biweekly intravenous CPT-11 and UFT/LV with HAI of 5-FU. In the phase II study, the primary endpoint was to determine the response rate. Results: In the phase I study, the recommended dose of CPT-11 for phase II study was 140 mg/m2 combined with UFT 300 mg/m2/day, LV 75 mg/body/day and 5-FU 2,000 mg/body/week. Sixteen patients were enrolled onto the phase II study. The six patients treated at the recommended dose during the phase I study also included in the phase II analysis (n = 22). Median number of liver metastases was 12 (range, 3 to 35). Median size of maximum diameter was 6.3 cm (range, 2.0 to 12.0 cm). The most common adverse event was neutropenia. The complete and partial response rate totaled 81.8%. Median survival time has not been reached yet. Eleven patients (50.0%) were ultimately able to undergo liver resection. Conclusions: The combination chemotherapy of CPT-11 and UFT/LV with HAI was safe, well tolerate and effective in current population of the patients with unresectable liver metastases from colorectal cancer. Updated toxicity and response data will be available in the spring of 2007. No significant financial relationships to disclose.

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Ocular melanoma liver metastases treated by percutaneous hepatic perfusion with melphalan followed by ipilimumab: A case report.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20008 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20008-e20008

Author(s):

Ahmad Fitri Idris ◽

Michael John Martin ◽

Ian R Davidson ◽

Gerard J O'Sullivan ◽

Ahmad A Jamaludin ◽

...

Keyword(s):

Side Effects ◽

Gall Bladder ◽

Liver Metastases ◽

Epigastric Pain ◽

Ocular Melanoma ◽

High Dose ◽

Hepatic Perfusion ◽

Pulmonary Angiogram ◽

Unresectable Liver Metastases ◽

Percutaneous Hepatic Perfusion

e20008 Background: Patients with unresectable liver metastases from ocular melanoma have a poor prognosis with just 10% surviving 1 year with standard treatments. High-dose melphalan via percutaneous hepatic perfusion (PHP) and filtration system (ChemoSat, Delcath Inc.) is licensed in Europe for treatment of liver-only metastases from ocular melanoma and neuroendocrine tumours. Ipilimumab (Ipi), anti-CTLA4 immunotherapy is licensed in US and Europe for treatment of metastatic malignant melanoma. A 32-year-old man was referred to our unit with unresectable liver metastases from primary ocular melanoma treated 8 years earlier. Here we describe the first report of sequential ChemoSat and Ipi in this setting. Methods: With assistance of an international proctoring team, and following on-site training, we treated this patient with ChemoSat according to manufacturer’s instructions (details at meeting). There were no immediate complications or subsequent hematological or other systemic chemotherapy side-effects. On day 4, the patient developed acute epigastric pain, pyrexia, ST elevation, and elevated troponin. Cardiac ECHO, coronary angiogram, CT pulmonary angiogram, abdominal USS and gastroscopy were normal. Blood cultures were repeatedly negative. He developed acute kidney injury secondary to intravenous contrast and NSAIDs. Repeat abdominal USS showed a thickened wall of gall bladder. A diagnosis of acute chemical cholecystitis was made. His symptoms settled, kidney function improved and he was discharged on day 23 of procedure. 10 weeks post ChemoSat the patient underwent treatment with Ipi 3mg/kg i.v. day 1, q 3/52 x 4 cycles which he received without significant side-effects. Results: MRI scan of liver 8 weeks post-ChemoSat (pre-Ipi) showed the liver lesions to be unchanged. CT scan 6 weeks post-Ipi treatment showed significant improvement. Conclusions: ChemoSat treatment is feasible and safe but can cause unexpected gall-bladder toxicity. Subsequent treatment with ipilimumab seems to be effective in this single case with short-term follow up.

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Outcomes of a Phase I/II Trial of Hepatic Arterial Infusion of Oxaliplatin Combined with Intravenous 5-Fluorouracil and l-Leucovorin in Patients with Unresectable Liver Metastases from Colorectal Cancer After Systemic Chemotherapy Failure

Journal of Gastrointestinal Cancer ◽

10.1007/s12029-016-9915-4 ◽

2017 ◽

Vol 49 (2) ◽

pp. 132-137 ◽

Cited By ~ 4

Author(s):

Yozo Sato ◽

Yoshitaka Inaba ◽

Takashi Ura ◽

Hideyuki Nishiofuku ◽

Hidekazu Yamaura ◽

...

Keyword(s):

Colorectal Cancer ◽

Phase I ◽

Liver Metastases ◽

Systemic Chemotherapy ◽

Hepatic Arterial Infusion ◽

Arterial Infusion ◽

Unresectable Liver Metastases

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6621 POSTER Percutaneous Hepatic Perfusion (PHP) With Melphalan for Patients With Unresectable Liver Metastases of Neuroendocrine Tumours (MNET) – NCT00096083

European Journal of Cancer ◽

10.1016/s0959-8049(11)71932-3 ◽

2011 ◽

Vol 47 ◽

pp. S478 ◽

Cited By ~ 2

Author(s):

J. Pingpank ◽

R.E. Royal ◽

U.S. Kammula ◽

A.W. Kam ◽

B.J. Wood ◽

...

Keyword(s):

Liver Metastases ◽

Neuroendocrine Tumours ◽

Hepatic Perfusion ◽

Unresectable Liver Metastases ◽

Percutaneous Hepatic Perfusion

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Fulminant Hepatic Failure after Chemosaturation with Percutaneous Hepatic Perfusion and Nivolumab in a Patient with Metastatic Uveal Melanoma

Case Reports in Oncological Medicine ◽

10.1155/2021/8870334 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Lindsey Teal ◽

Jeffrey Yorio

Keyword(s):

Liver Metastases ◽

Uveal Melanoma ◽

Fulminant Hepatic Failure ◽

Immune Checkpoint ◽

Hepatic Failure ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

High Dose ◽

Hepatic Perfusion ◽

Percutaneous Hepatic Perfusion

Immune checkpoint inhibitors, such as nivolumab, a programmed death receptor-1 (PD-1) inhibitor, have dramatically improved the treatment of advanced melanomas. Chemosaturation with percutaneous hepatic perfusion (PHP) delivers chemotherapy in high doses directly to the liver and is a potentially effective treatment modality in metastatic uveal melanoma with liver metastases. Its safety and effectiveness have not been studied in patients also receiving immunotherapy. A 46-year-old male with a history of uveal melanoma of the right eye was found to have liver metastases. He was treated with PHP using high-dose melphalan for 6 months with a partial response followed by progression. Two months after his last PHP treatment, the patient was started on nivolumab. After two doses of nivolumab, the patient developed severe hepatitis that progressed to fulminant hepatic failure and death despite treatment with high-dose corticosteroids and mycophenolate mofetil. Nivolumab and other immune checkpoint inhibitors have been effective in treating advanced melanoma and extending life. However, there are serious immune adverse events that can occur. While hepatitis after taking nivolumab has been documented, fulminant hepatic failure is rare. We believe that prior PHP treatment contributed to the severity of the hepatitis and, ultimately, fulminant hepatic failure. To our knowledge, this is the only case of fulminant hepatic failure secondary to a checkpoint inhibitor with preceding PHP. Specific precautions should be made in patients who have been exposed to PHP in the past, and further studies should be done to assess the safety of using checkpoint inhibitors after PHP.

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