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

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.

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

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.

Isolated and Percutaneous Hepatic Perfusion for Unresectable Liver Metastases: A Systematic Review

2021 ◽  
Vol 05 (11) ◽  
Author(s):  
Bagias G ◽  
Antonakis P ◽  
Memos N ◽  
Panopoulou E ◽  
Toutouzas K ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Metastases ◽  
Hepatic Perfusion ◽  
Unresectable Liver Metastases ◽  
Percutaneous Hepatic Perfusion

Isolated (hypoxic) hepatic perfusion with high-dose chemotherapy in patients with unresectable liver metastases of uveal melanoma

2016 ◽  
Vol 26 (6) ◽  
pp. 588-594 ◽  
Author(s):  
Eleonora M. de Leede ◽  
Mark C. Burgmans ◽  
Ellen Kapiteijn ◽  
Gre P.M. Luyten ◽  
Martine J. Jager ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Uveal Melanoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hepatic Perfusion ◽  
Unresectable Liver Metastases

scholarly journals Chemosaturation with percutaneous hepatic perfusion is effective in patients with ocular melanoma and cholangiocarcinoma

2020 ◽  
Vol 146 (11) ◽  
pp. 3003-3012 ◽  
Author(s):  
Leon Schönfeld ◽  
Jan B. Hinrichs ◽  
Steffen Marquardt ◽  
Torsten Voigtländer ◽  
Cornelia Dewald ◽  
...  
Keyword(s):  
Medical School ◽  
Liver Tumors ◽  
Interventional Procedure ◽  
Venous Blood ◽  
Hepatic Metastases ◽  
Ocular Melanoma ◽  
Liver Malignancies ◽  
Hannover Medical School ◽  
Hepatic Perfusion ◽  
Percutaneous Hepatic Perfusion

Abstract Background Chemosaturation with percutaneous hepatic perfusion (CS-PHP; Hepatic CHEMOSAT® Delivery System; Delcath Systems Inc, USA) is a novel interventional procedure, which delivers high doses of melphalan directly to the liver in patients with liver tumors while limiting systemic toxicity through hemofiltration of the hepatic venous blood. We have previously shown promising efficacy for patients with ocular melanoma (OM) and cholangiocarcinoma (CCA) within our single-center and multi-center experiences. The aim of this study was to analyze the safety and efficacy of CS-PHP after 141 treatments at Hannover Medical School, Germany. Methods Overall response rates (ORR) were assessed according to Response Evaluation Criteria In Solid Tumors (RECIST1.1). Median Overall survival (mOS), median progression-free survival (mPFS), and median hepatic PFS (mhPFS) were analyzed using the Kaplan–Meier estimation. Results Overall, 60 patients were treated with CS-PHP in the salvage setting from October 2014 until January 2019 at Hannover Medical School with a total of 141 procedures. Half of the patients were patients with hepatic metastases of ocular melanoma (OM) (n = 30), 14 patients had CCA (23.3%), 6 patients had hepatocellular carcinoma (10%), and 10 patients were treated for other secondary liver malignancies (16.7%). In total, ORR and disease stabilization rate were 33.3% and 70.3% (n = 25), respectively. ORR was highest for patients with OM (42.3%), followed by patients with CCA (30.8%). Independent response-associated factors were normal levels of lactate dehydrogenase (odds ratio (OR) 13.7; p = 0.015) and diagnosis with OM (OR 9.3; p = 0.028). Overall, mOS was 9 months, mPFS was 4 months, and mhPFS was 5 months. Patients with OM had the longest mOS, mPFS, and mhPFS with 12, 6, and 6 months, respectively. Adverse events included most frequently significant, but transient, hematologic toxicities (80% of grade 3/4 thrombopenia), less frequently hepatic injury up to liver failure (3.3%) and cardiovascular events including two cases of ischemic insults (5%). Conclusion Salvage treatment with CS-PHP is safe and effective particularly in patients OM and CCA. Careful attention should be paid to possible, serious hepatic, and cardiovascular complications.

scholarly journals Analysis of Factors Associated with Outcome in Patients Undergoing Isolated Hepatic Perfusion for Unresectable Liver Metastases from Colorectal Center

2009 ◽  
Vol 16 (7) ◽  
pp. 1852-1859 ◽  
Author(s):  
H. Richard Alexander ◽  
David L. Bartlett ◽  
Steven K. Libutti ◽  
James F. Pingpank ◽  
Douglas L. Fraker ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Hepatic Perfusion ◽  
Factors Associated ◽  
Isolated Hepatic Perfusion ◽  
Unresectable Liver Metastases
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