Hepatic Chemoperfusion: A Comparison between Old and New Generation Filters in Patients Affected by Liver Metastasis from Melanoma
Despite immunotherapy and targeted therapies, have significantly improved patients expectations, effective approach to non-resect able liver metastatic melanomas remains a major challenge in interdisciplinary oncology. Patients with liver metastases usually die of their disease, mostly due to acquired resistances to systemic drugs and to persistence of micro-metastatic clones.
Recently, whole organ-focused strategies had been proposed in order to extend patient’s benefits addressing those complains. In particular, liver chemoperfusion with Delcath CHEMOSAT® product (CS-HDS) is designed to perfuse the entire liver with a chemotherapeutic agent (melphalan hydrochloride), with simultaneous extra-corporeal filtration of the hepatic venous blood, in order to remove the drug before it is returned to the systemic circulation
Three patients affected by metastatic melanoma with liver involvement only, received repeated cycles of CS-HDS, using two different devices for Melphalan (L-PAM) filtration. In vitro, the second generation filter (GEN2) offers a better L-PAM filtration in comparison with the first generation one (GEN1) reaching 98% of the drug recovery versus previous 88%-90%. This means that a very limited amount of drug should be able to reach the systemic circulation avoiding relevant toxicities. No data are available for in vivo confirmation of this statement. Here we compare toxicities observed in three patients who experienced chemoperfusion with both the filters.