New procedure could bring hope to people with advanced eye cancer
A medical breakthrough could be on the way for a rare cancer with no effective treatment. Ocular melanoma strikes two-thousand Americans each year, but a new treatment could possibly put a stop to the spread of the disease.
Forty-three-year-old Sabrina Frey is a mother of four boys and she has ocular melanoma, which has metastasized to her liver. She knows she may be short on time.
"I’m pounding the pavement looking for any option," said Frey.
She has scoured the internet in search of anything that will prolong her life.
"I tried lots of different things," Frey said. "I had a liver resection. I tried immunotherapies."
Now she is in the operating room trying percutaneous hepatic perfusion or PHP. Doctor Jonathan Zager has done this procedure on about 60 patients.
"I think it is a breakthrough treatment," said Dr. Zager.
Doctor Zager says during surgery the liver is blocked off from the rest of the body, and then saturated with high doses of chemotherapy through a catheter for 30 minutes. A balloon prevents outflow from the liver into the rest of the body.
"We filter the chemotherapy laden blood outside the body and then the clean blood returns to the patient with another catheter in their neck," said Dr. Zager.
Sabrina has done PHP three times so far and she can do it up to six times about every eight weeks.
"We keep on going to second, third, fourth, fifth and sixth procedure as long as they’ve tolerated the previous procedure well," said Dr. Zager.
It’s working for Sabrina, as her tumors are shrinking.
"Some tumors are not actually even visible on my MRI’s anymore," said Frey.
Doctor Zager says so far most patients are responding well to this treatment.
"I just have to hold on long enough till they find a cure," said Frey.
It looks like PHP is helping her do just that. Doctor Zager says the earlier patients start this treatment the better.
Candidates for this procedure must have good liver function and not many tumors. If ocular melanoma is localized to the eye, prognosis is good, but 50 percent of ocular melanoma cancers spread.
TOPIC: PHP Attacks Ocular Melanoma
REPORT: MB #4156
BACKGROUND: Ocular melanoma is the most common cancer of the eye in adults. Melanoma is a cancer that develops from the cells that produce the dark-colored pigment melanin. While this is known to be responsible for your skin color, it is also found in other places such as our hair, the lining of our organs, and our eyes. Ocular melanoma occurs when these cells form a cancer in the eye. It is diagnosed in about 2,500 adults every year in the United States. Ocular melanoma (OM) is a malignant tumor that can grow and spread. This process is known as metastasis and is often fatal, especially if spread to the liver. It occurs in about half of all cases. OM is different from skin melanoma and is not related to sun exposure. It represents about 5% of all melanomas. In the majority of cases, it develops slowly from the pigmented cells of the choroid, but it also can develop from pigmented cells of the iris and ciliary body.
TREATMENT: Once a diagnosis of ocular melanoma is made, choice of treatment depends on the location, site of origin within the eye, size of the tumor, as well as patient age, overall health, visual potential and status of the unaffected eye. Because OM is resistant to conventional systemic therapies, early diagnosis and treatment is essential. If the melanoma has metastasized, or spread, it can be more difficult to treat. For most small and medium-sized tumors, radiation is the recommended treatment. The types of radiation include plaque radiotherapy, proton beam radiotherapy, and stereotactic radiotherapy. In some cases, the recommended treatment for ocular melanoma is surgical removal of the tumor. Surgery is often recommended for tumors of large size and for iris melanomas. Surgery may also be recommended for recurrent disease after initial radiation treatment. Additional treatments that may be recommended are transpupillary thermotherapy and intraocular injections. There are currently no approved treatments for metastatic OM. If it has spread to the liver, it can be difficult to treat, but there are a variety of liver-focused experimental treatment options, often as a part of new clinical trials.
NEW TREATMENT: Percutaneous hepatic perfusion (PHP) is a minimally invasive procedure being tested to treat metastatic ocular melanoma. During the procedure a small needle punctures in the skin to access the liver, rather than a large incision. The surgeons insert a special catheter, with a balloon on either end, through several of these needle punctures in the skin. Once the catheters are in place, the balloons are inflated to seal off the vein above and below the liver to isolate it. The blood inside the liver is removed and high-dose, heated chemotherapy is infused through the liver. Charcoal filters remove chemotherapy from the blood as it is returned to the body. Doctors are confident that people with melanoma that has spread to the liver respond well to the treatment.
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