Among patients with melanoma that has spread primarily to the liver, delivery of chemotherapy directly to the liver through a process known as percutaneous hepatic perfusion (PHP) delayed the progression of liver metastases. These results were presented at the 2011 European Multidisciplinary Cancer Conference.
The liver is a common site of cancer spread. Effective treatment of liver metastases can improve survival in some patients, and researchers continue to explore new approaches to treating the liver.
Percutaneous hepatic perfusion (PHP) delivers very high doses of chemotherapy (in this case, melphalan), directly to the liver via the hepatic artery. As blood leaves the liver, filters are used to remove the drug from the blood before the blood travels to other parts of the body. This minimizes exposure of the rest of the body to the drug, and allows for higher doses to be administered to the liver.
To evaluate PHP for the treatment of liver metastases, researchers conducted a Phase III clinical trial among 93 melanoma patients. All of the patients had liver metastases that could not be surgically removed. Patients were assigned to receive PHP or best alternative therapy. Alterative therapies could include treatments such as interleukin 2, systemic (whole-body) chemotherapy, or transcatheter arterial chemoembolization (TACE).
- Survival without worsening of the liver metastases was 8.1 months among patients treated with PHP compared with only 1.6 months among patients treated with best alternative care.
- Overall survival was not significantly different in the two study groups (11.4 months in the PHP group versus 9.9 months in the best alternative care group); this is most likely the result of patients switching over to PHP after cancer progression.
- Side effects of PHP included low white blood cell counts and low platelet counts.
These results suggest that high doses of melphalan delivered directly to the liver through PHP delays the progression of liver metastases in patients with melanoma.
Reference: Pingpank JF, Hughes M, Alexander HR et al. Percutaneous hepatic perfusion (PHP) vs. best alternative care (BAC) for patients (pts) with melanoma liver metastases – efficacy update of the phase 3 trial (NCT00324727). Presented at the 2011 European Multidisciplinary Cancer Conference. Stockholm, Sweden. September 23-27, 2011. Abstract 9304.