{"entity":{"id":"percutaneous-hepatic-perfusion","kind":"technology","name":"Percutaneous hepatic perfusion (chemosaturation)","aka":[],"tldr":"Isolating the liver's circulation with catheters and balloons so that high-dose melphalan can be pumped through it and filtered out before it reaches the rest of the body; approved in 2023 for eye melanoma that has spread to the liver.","summary":"PHP (Delcath Hepzato/CHEMOSAT) uses a double-balloon catheter in the inferior vena cava to capture hepatic venous outflow, which is passed through activated-carbon filters before return, while melphalan 3 mg/kg is infused into the hepatic artery for 30 minutes. FOCUS trial (2023): 36% response and 74% disease control in uveal melanoma liver metastases with median PFS ~9 months; FDA approval August 2023 (Hepzato Kit, with REMS for myelosuppression and haemorrhage). CE-marked since 2012 in Europe, also used for cholangiocarcinoma and neuroendocrine liver metastases. It joins hepatic arterial infusion pumps (FUDR for colorectal liver metastases, MSK), TACE and radioembolisation among liver-directed therapies.","status":"approved","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Hepatic_arterial_infusion","links":[{"label":"FOCUS trial (Ann Surg Oncol 2024)","url":"https://doi.org/10.1245/s10434-024-15293-x"},{"label":"Hepzato Kit label","url":"https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Hepzato"}],"tags":["gap-fill"],"related":[],"cancers":["uveal-melanoma","cholangiocarcinoma","neuroendocrine"],"sections":["devices","surgery"],"technologies":["tace","radioembolisation-tare","isolated-limb-perfusion"],"targets":[],"drugs":["melphalan","tebentafusp"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["nct02678572","nct06519266","nct05022901"],"people":[],"bottlenecks":[],"keyPapers":["paper-zager-ann-surg-oncol"],"journals":[],"dependsOn":[],"notes":[],"principle":"Regional isolation and extracorporeal filtration allow hepatic melphalan exposure roughly ten-fold higher than systemic tolerance, exploiting the liver-dominant metastatic pattern of uveal melanoma.","strengths":["Randomised/pivotal evidence in a disease with few options","Repeatable (up to 6 cycles)","Treats the whole liver, including occult disease"],"limitations":["Myelosuppression despite filtration; bleeding, hepatic injury","Requires specialised interventional radiology and anaesthesia","Liver-only benefit; extrahepatic disease progresses"],"since":2010},"route":"/technologies/percutaneous-hepatic-perfusion/","neighbours":{"cancer":[{"id":"cholangiocarcinoma","kind":"cancer","name":"Biliary tract cancer (cholangiocarcinoma)","route":"/cancers/cholangiocarcinoma/"},{"id":"neuroendocrine","kind":"cancer","name":"Neuroendocrine tumours","route":"/cancers/neuroendocrine/"},{"id":"uveal-melanoma","kind":"cancer","name":"Uveal melanoma","route":"/cancers/uveal-melanoma/"}],"section":[{"id":"devices","kind":"section","name":"Devices & Physical Therapies","route":"/fronts/devices/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"isolated-limb-perfusion","kind":"technology","name":"Isolated limb perfusion and infusion","route":"/technologies/isolated-limb-perfusion/"},{"id":"radioembolisation-tare","kind":"technology","name":"Radioembolisation (TARE / SIRT, yttrium-90)","route":"/technologies/radioembolisation-tare/"},{"id":"tace","kind":"technology","name":"Transarterial chemoembolisation (TACE)","route":"/technologies/tace/"}],"drug":[{"id":"melphalan","kind":"drug","name":"Melphalan (including hepatic delivery system)","route":"/drugs/melphalan/"},{"id":"tebentafusp","kind":"drug","name":"Tebentafusp","route":"/drugs/tebentafusp/"}],"trial":[{"id":"nct05022901","kind":"trial","name":"An Open-Label Expanded Access Study of the Melphalan/Hepatic Delivery System (HDS) in Patients With Hepatic Dominant Ocular Melanoma","route":"/trials/nct05022901/"},{"id":"nct02678572","kind":"trial","name":"FOCUS","route":"/trials/nct02678572/"},{"id":"nct06519266","kind":"trial","name":"PHP in Combination With IPI1/NIVO3 Compared to IPI3/NIVO1 Only in Patients With Uveal Melanoma Liver Metastases","route":"/trials/nct06519266/"}],"paper":[{"id":"paper-zager-ann-surg-oncol","kind":"paper","name":"Efficacy and Safety of the Melphalan/Hepatic Delivery System in Patients with Unresectable Metastatic Uveal Melanoma: Results from an Open-Label, Single-Arm, Multicenter Phase 3 Study","route":"/key-papers/paper-zager-ann-surg-oncol/"}],"term":[{"id":"liver-directed-therapy","kind":"term","name":"Liver-directed therapy (TACE, TARE, HAI, ablation)","route":"/terms/liver-directed-therapy/"}]}}