Background: Patients with unresectable melanoma or sarcoma hepatic metastases have poor prognosis with few treatment options. PHP is effective with reported hepatic overall response rates of up to 81% and median hepatic progression free survival of up to 10.9 months. An international multicenter phase 3 trial is underway (NCT02678572).
Methods: After general anesthesia induction, patients are anticoagulated with target activated clotting time of >400 seconds. An infusion catheter is introduced through a 5 Fr femoral arterial sheath into the proper hepatic artery. A 16 Fr double-balloon hepatic isolation and aspiration catheter is introduced through an 18 Fr femoral venous sheath into the inferior vena cava (IVC). The cephalad balloon is inflated in the right atrium under fluoroscopic guidance and retracted to occlude the IVC. The caudal balloon is inflated superior to the renal veins. This catheter is fenestrated, shunting hepatic venous outflow to an extracorporeal filter and returned via a 10 Fr catheter in the internal jugular vein. The melphalan dose is 3 mg/kg ideal body weight and administered into both hepatic arteries over 30 minutes followed by 30 minutes of passive washout.
Results: Among 29 patients, 98/100 PHPs were completed successfully. A median of 3 PHPs (range 1-6) were performed for ocular melanoma (n=22), cutaneous melanoma (n=3), melanoma of unknown primary (n=1) and sarcoma (n=3). Bone marrow toxicity was frequently seen (100%) and treated as an outpatient with growth factors.
Conclusions: We present a description of our PHP procedure. A dedicated team allows PHP to be safely performed.
