PHP may increase survival in patients with liver metastases

Source: Healio.com, Heptalogy, April 2015

Percutaneous hepatic perfusion increased hepatic progression free and overall survival rates in patients with liver metastases from melanoma vs. patients who underwent yttrium-90 therapy, according to data presented at the 2015 Society of Surgical Oncology Annual Cancer Symposium.

Jonathan S. Zager, MD, FACS, director of regional therapies and chair of graduate medical education at Moffitt Cancer Center in Tampa, and colleagues, including Andrea M. Abbott, MD, of surgical oncology at Moffitt Cancer Center, analyzed data of 30 patients with cutaneous or uveal melanoma that metastasized to the liver after treatment with percutaneous hepatic perfusion (PHP), yttrium-90 (Y90) or chemoembolization using melphalan hydrochloride for injection with the Delcath Hepatic Delivery System (Melphalan/HDS, Delcath Systems, Inc.). The Melphalan/HDS is a system designed to supply high-dose chemotherapy to the liver while controlling systemic exposure, according to the Delcath website.
The goal of the retrospective research was to differentiate between hepatic progression free survival (HPFS), progression free survival (PFS) and OS rates between the treatments. Of the 30 patients, six were treated with Y90, 10 were treated with PHP, 12 were treated with chemoembolization, one underwent PHP and received Y90 after PHP and one other patient received PHP after chemoembolization.

Patients who underwent PHP had a significantly greater median HPFS compared with patients who underwent chemoembolization or Y90 (310 days vs. 80 and 54 days). Analyses showed improved HPFS for PHP compared with Y90 (P = .001) and chemoembolization (P = .008). However, HPFS was different between the chemoembolization vs. Y90 groups (P = .44).

“This small retrospective series shows that there is a hepatic progression free and overall progression free survival advantage to perfusing the entire liver through a percutaneous hepatic perfusion, which targets macroscopic and microscopic disease, vs. radioembolization with Y90 or chemoembolization,” Zager told Healio.com/Hepatology. “Y90 and [chemoembolization], while effective in treating clinically/radiographically obvious disease, might not target the clinically/ radiographically occult disease seen in uveal melanoma in the liver.”

Patients who underwent PHP had a higher median OS rate compared with patients who underwent Y90 and chemoembolization (736 days vs. 285 and 265 days), respectively.

Multivariate analyses showed a difference in OS for PHP compared with Y90 (P = .03). However, no significant difference was observed in PHP vs. chemoembolization (P = .37) or chemoembolization vs. Y90 (.06). PHP treatment was a predictor of PFS, according to the abstract.

“Overall survival was significantly improved with PHP over Y90, but not with PHP vs. CE. While these results are encouraging, larger studies are needed to understand the true regional control and overall survival impact of PHP, Y90 and CE in the regional therapy of hepatic metastases from uveal melanoma,” Zager said. – by Melinda Stevens