Percutaneous Hepatic Perfusion for Metastatic Uveal Melanoma

Altan Ahmed, MD, Moffitt Cancer Center, Tampa, Florida, discusses percutaneous hepatic perfusion (PHP) as a treatment option for patients with metastatic uveal melanoma. Dr Ahmed explains the referral process, the importance of multidisciplenary support, and the follow-up process. He stressed, PHP as "a big opportunity for IRs to be on the forefront of offering these therapies for patients who otherwise may be exhausting multiple lines of chemotherapy and other systemic therapies. It offers a novel and innovative way to treat patients who may not have a lot of options."

Transcript:

My name is Altan Ahmed. I'm one of the international radiologists at Moffitt Cancer Center. I'm here at the CIO 2024 meeting discussing percutaneous hepatic perfusion for the treatment of uveal melanoma metastatic disease. Uveal melanoma is a rare but devastating disease affecting about 1,700 patients in the United States every year. There are limited treatment options for this otherwise devastating disease, as I mentioned. Systemic therapies have not really panned out to date. Percutaneous hepatic perfusion offers a minimally invasive method to treat these patients with a remarkable response rate.
 
Referral for these patients who are usually self-directed or coming from the medical oncology community. Up until 2022, there was no systemic therapy for uveal melanoma, and now we have to tebentafusp. Unfortunately, this is HLA-dependent, so only 45% of Caucasian patients will be eligible for this therapy. PHP, on the other hand, is HLA-agnostic, so as long as someone is relatively healthy other than their cancer diagnosis, they will be a candidate for this therapy.
 
The PHP procedure itself is a very resource-intensive procedure. It requires close multidisciplinary collaboration between interventional radiology, perfusion therapy, and anesthesiology. In some centers, there's also collaboration with surgical oncology colleagues. Like I mentioned it requires very close collaboration to make sure the patient is kept safe from the beginning to the end of the procedure. It typically requires an overnight stay for the patient but after that overnight stay most patients are discharged uneventfully.
 
The follow-up for percutaneous hepatic perfusion is typically every 12 weeks or so, we do imaging. The procedure can be repeated up to 6 times every 6 to 8 weeks, so depending on response, as long as somebody's stable in their disease or continuing to respond without major toxicities, mainly bone marrow toxicity, we would continue on with the treatment. Bone marrow toxicity is usually cytopenia or low platelets. Occasionally anemia, or low red blood cell counts, or low white cell counts. Those are treated with medications to help support the bone marrow in terms of white blood cell counts and transfusions as needed.
 
It's very important for physicians and IRs in general to be familiar with this therapy because regional perfusional therapies have not played a large role in contemporary IR practice. That’s including uveal melanoma, but extending to other disease processes. I think it's a big opportunity for IRs to be on the forefront of offering these therapies for patients who otherwise may be exhausting multiple lines of chemotherapy and other systemic therapies. It offers a novel and innovative way to treat patients who may not have a lot of options.