Introduction
Patient Selection
References | Year | No. pts (no. PHPs) | Type of hepatic malignancy (n) | Chemotherapy | Type of study | Intervention | Endpoint | OR R % (n) | hPFS, median | OS, median | Complicationsc
|
---|---|---|---|---|---|---|---|---|---|---|---|
Hughes et al. [53] | 2015 | 93 (max 6 per pt) | Melanoma (ocular 83; cutaneous 10) | Melphalan | RCT | PHPb
| Response (primary: hPFS) | 27.3 % (vs 4.1 % in control) | 7.0 months (vs 1.6 in controls) | 10.6 months (vs 10.0 in controls)Ω
| Neutropenia (85.7 %), thrombocytopenia (80.0 %), anemia (62.9 %), self-limiting hyperbilirubinemia (14.3 %), cardiac toxicity (12.9 %), cerebral ischemia (1.2 %), death 3.2 % |
Vogl et al. [46] | 2014 | 14 (18) | Melanoma (ocular 8; cutaneous 3), Gastric/Breast/CA (1) | Melphalan | Retrospective | PHPb
| Response and toxicity | 54 (7) | n.r. | n.r. | Pancytopenia; death (7.1 %; retroperitoneal hemorrhage) |
Fitzpatrick et al. [57] | 2014 | 5 (15) | Melanoma (ocular 4; cutaneous 1) | Melphalan | Case series | PHPb
| Feasibility and toxicity | n.r. | n.r. | n.r. | Transient mild hypothermia and metabolic acidosis |
Fukumoto et al. [42] | 2014 | 68 (103) | HCC, BCLC intermediate (27) or advanced (41) | Mitomycin C and/or doxorubicin | Prospective | Resection + PHP | Response | 70.6 (48) | n.r. | 25 months | Leukopenia (44.1 %), serum AST gr. 3/4 (77.9 %), hair loss (72 %), gastroduodenal ulcer (4.4 %) |
Forster et al. [52] | 2013 | 10 (27) | Melanoma (ocular 5; cutaneous 3, unknown 1). Sarcoma (1) | Melphalan | Retrospective | PHPb
| Response and toxicity | 50 (5) | 240 days | n.r. | Bone marrow suppression; mild elevation serum troponin (70 %) |
Pingpank et al. [58] | 2011a
| 23 (68) | NET (23) | Melphalan | Prospective | PHPb
| Response (ORR) | 79 | 39 months | n.r. | Acute transaminitis gr 3/4 (22 %); neutropenia 47 %, thrombocytopenia 29 %, anemia (15 %). Death 0.04 % (cholangitis) |
Miao et al. [30] | 2008 | 51 (136) | Melanoma (ocular 12, cutaneous 4), NET (12), CRC (7), HCC (5), RCC (4), AdrC/Breast/CA (2), Ewing (1) | Melphalan | Prospective | PHPb
| Hemodynamics and metabolic changes | n.r. | n.r. | n.r. | Transient hypotension and metabolic acidosis; nausea/vomiting (10 %) |
Pingpank [39] | 2005 | 28 (74) | Melanoma (ocular 10, cutaneous 3), CRC (2), Hepatobiliary (3), NET (4), RCC (2), AdrC/Breast/Sarcoma/PA (1) | Melphalan | Phase I | PHPb
| MTD, toxicity, pharmacokinetics | 29.6 (8) | n.r. | n.r. | Neutropenia gr 3/4 (73.6 %); thrombocytopenia gr 3/4 (36.8 %); anemia (21.1 %)e
|
Ku et al. [59] | 2004 | 22 (40) | HCC (22) | Doxorubicin | Prospective | resection + PHP | Efficacy | 86 (19) | n.r. | 1 and 5 years OS: 86 and 47 % | Leukopenia (45.5 %), hair loss (63.6 %) |
Savier et al. [48] | 2003 | 4 (10) | Breast/CRC/Gastric/CA (1) | Melphalan | Prospective study | IHP + PHP | Feasibility; pharmacokinetics | n.r. | n.r. | n.r. | Neutropenia grade 3/4 (50 %) |
Ku et al. [56] | 1998 | 28 (39) | HCC, TNM III (1) or IV-A (27) | Doxorubicin | Prospective | PHP | Response and survival | 63 (17) | n.r. | 16 months | Chemical hepatitis (71 %), leukopenia (54 %), hair loss (43 %), thrombocytopenia (18 %), hemolysis/hematuria (57 %), gastroduodenal ulcer (7 %), death 8 % due to pancreatitis (4 %) and HAT (4 %) |
Ku et al. [60] | 1997 | 16 (16) | HCC (11), CRC (1), Breast CA (1), Melanoma (1) | Doxorubicin | Prospective | PHP | Hemodynamics, pharmacology, toxicity | n.r. | n.r. | n.r. | Chemical hepatitis (75 %), leukopenia (43.7 %), alopecia (37.5 %), thrombocytopenia (25 %), hemolysis/hematuria (50 %) |
Ku et al. [40] | 1995 | 15 (15) | HCC, unresectable (15) | Doxorubicin | Phase I | PHP | Hemodynamics, pharmacology, toxicity, response | 64 (9) | n.r. | 12 months for responders (vs 5 for non-responders) | Chemical hepatitis (71 %), leukopenia (67 %), alopecia (33 %), thrombocytopenia (40 %), hemolysis/hematuria (87 %), gastroduodenal ulcer (14 %), death 13.3 % due to pancreatitis (7 %) and HAT (7 %) |
Ravikumar et al. [29] | 1994 | 21 (58) | HCC (5), CRC (8), Melanoma (2), Sarcoma (4), Adrenal/Pancreatic/SCLC/CA (n = 1) | 5-FU, doxorubicin | Phase I | PHP | MTD, feasibility | 9.5 (2) | n.r. | n.r. | Hematologic, primarily leukopenia/neutropenia; transient hypotension (78.5 %) |
Hepatic Vascular Mapping
PHP Procedure
Anesthesiology and Perfusionist Support
Chemotherapeutic Agent
Post-procedural Care
Complications
Leakage to the Systemic Circulation
Results of PHP to Date
Future Directions
Study design | Type of hepatic malignancy | Initiation | Treatment | Estimated enrollment | End-points | Status |
---|---|---|---|---|---|---|
Phase II, single center | Ocular melanoma | Investigatora
| PHP with melphalan. 2 cycles | 20 | ORR, post-PHP resectability safety, OS, HPFS, PFS, QoL | Recruiting |
Phase III, multicenter | Ocular melanoma | Industryb
| PHP with melphalan. Max 6 cycles versus BAC (dacarbazine, TACE, ipilimumab or pembrolizumab) | 240 | OS, PFS, ORR, HPFS, hepatic ORR, QoL | Launching fourth quarter 2015 |
Phase II, single center | Colorectal carcinoma | Investigatora
| PHP with melphalan. 2 cycles | 34 | ORR, post-PHP resectability safety, OS, HPFS, PFS, QoL | Recruiting |
Phase II, multicenter | HCC or ICC | Industryb
| PHP with melphalan. 2 Cycles | 42 | ORR, safety, PFS | Recruiting |
Phase II, multicenter | HCC | Industryb
| PHP with melphalan. 3 cycles, followed by sorafenib | 31 | Adverse events, ORR, PFS, pharmacokinetics, QoL | Recruiting |
Phase I/II | HCC | Investigatorc
| PHP followed by sorafenib | 30 | PFS, OS, safety | Recruiting |