Science et thérapie du cancer

Percutaneous Isolated Hepatic Perfusion with Melphalan in Combination with Immunotherapy for Patients with Hepatic Metastasis of Uveal Melanoma

Abstract

Lukas Trennheuser, Daniel Schneider, Ulf Neuberger, Carsten Schulz, Hans-Ulrich Kauczor, Alexander H Enk and Jessica C Hassel

Objective: Percutaneous isolated hepatic perfusion (PIHP) is becoming increasingly important for the treatment of hepatic metastasis of uveal melanoma. However, the best treatment strategy is not yet clear.

Method: We present a case series of seven patients suffering from hepatic metastases of uveal melanoma who received several treatments of PIHP with melphalan, with or without immunotherapy.

Results: Seven patients with hepatically metastasized uveal melanoma (three men, four woman) with an average age of 51 years (range 37–68 years) received two cycles of PIHP at intervals of 4–10 weeks and were then monitored clinically (three patients) or treated with a PD-1 antibody ± ipilimumab (six patients) until disease progression or intolerable toxicity was determined. Two cycles of PIHP controlled the disease for between 3.9 and 15.6 months, resulting in a median hepatic progression-free survival (hPFS) of 7.3 months. A further 1–2 PIHP cycles were then performed, followed by anti-PD1 therapy for two patients, resulting in short-term control of the disease only. Median hPFS until final disease progression (measured from first PIHP until progression despite PIHP) was 15.4 months (Range 3.9–24.9), and overall survival was 16.8 months (Range 4.8–36.0). The first two PIHP cycles in particular were very well tolerated.

Conclusion: Although conclusions from small case series should be drawn with caution, the clinical experiences described provide the first indications that two treatment cycles of PIHP might suffice to control hepatic metastasis of uveal melanoma for several months. Additional immunotherapy might benefit patients after a reduction of tumour load by PIHP. Side effects and treatment risks seem lower with this treatment scheme. Further studies on this topic are warranted.