Is liver-targeted chemotherapy effective?

This phase II clinical trial assessed the efficacy of a treatment called isolated hepatic perfusion (IHP) for the treatment of patients with liver metastases from ocular melanoma.

Ocular (uveal) melanoma is cancer of the pigmented cells (called melanocytes) of the eye. Although most patients undergo successful treatment of the melanoma, some patients can develop metastases (cancer that has spread to distant organs and tissues of the body). The most common site of metastasis is the liver. Systemic (whole body) chemotherapy (use of cytotoxic drugs to kill or stop the growth and spread of cancer cells) may be used in the treatment of liver metastasis. However, for this treatment to be effective there is need for a high dose of drugs, which can also damage other healthy cells in the body. Isolated hepatic perfusion or IHP is a procedure used to deliver high doses of chemotherapy directly into the liver through a catheter (a thin tube used in healthcare to deliver medications or to drain bodily fluids) placed into the artery that provides blood to the liver. This study aimed to evaluate IHP as treatment for liver metastases in patients with ocular melanoma. 

This study included 34 patients with primary ocular melanoma who developed liver metastases and who underwent IHP. The main parameters evaluated were overall response rate or ORR (defined as the percentage of patients whose cancer shrinks or disappears after the treatment) and overall survival (OS). 

Results showed an ORR of 68%, with 12% of the patients having a complete response (disappearance of ll cancer cells) and 56% having a partial response (a decrease in the size of the tumor), while 18% of the patients had stable disease (no change in the size of the tumor) and 15% of the patients had progressive disease (the tumor keeps growing or spreading). However, 68% of patients developed metastases in other places than the liver within 13 months of the treatment. OS after IHP was approximately 24 months. When compared to other patients with liver metastases from ocular melanoma who have not been treated with IHP, there was a significant survival advantage of 14 months in favor of patients who underwent IHP.

In summary, this trial showed that IHP improved both OS and OR in patients with liver metastases from ocular melanoma.

The trial involved a very small number of patients. Future trials with a larger group of patients are needed for more reliable results.

Consult your physician on the most appropriate treatment in your situation.