Percutaneous hepatic perfusion with melphalan for metastatic uveal melanoma: mounting evidence and future perspectives

Abstract

Metastatic uveal melanoma (UM) represents a formidable challenge in oncology, characterized by limited treatment options and a poor prognosis. After successful treatment for the primary tumor, up to 50% of patients will develop metastases, mainly to the liver. Percutaneous hepatic perfusion with Melphalan (M-PHP) is a minimally invasive treatment option for patients with liver-dominant metastatic disease and is discussed in this thesis. Firstly, part I provides an overview of the outcomes of UM patients diagnosed in the Netherlands over a period of thirty years (1989 – 2019). In part II, the results of M-PHP in three European centers are presented. Furthermore we describe a prospective analysis on the quality of life of patients who underwent M-PHP for metastatic UM. In the last part of the thesis the ongoing CHOPIN trial is introduced. In this trial a novel combination of M-PHP with systemic immunotherapy (ipilimumab and nivolumab) is applied. The results of the phase Ib part of the CHOPIN study are presented, showing that a combination of M-PHP with ipilimumab at 1mg/kg and nivolumab at 3mg/kg is safe and feasible in patients with hepatic metastases from UM.