# Percutaneous hepatic perfusion (chemosaturation)

Source: https://onco.cc/technologies/percutaneous-hepatic-perfusion/  
OnCo record `percutaneous-hepatic-perfusion` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Technology
- Status: approved
- Last checked: 2026-09-08
- Tags: gap-fill
- 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.
- Since: 2010
- 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

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hepatic_arterial_infusion
- FOCUS trial (Ann Surg Oncol 2024): https://doi.org/10.1245/s10434-024-15293-x
- Hepzato Kit label: https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Hepzato

## Connected records

- cancers: [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Neuroendocrine tumours](https://onco.cc/cancers/neuroendocrine/), [Uveal melanoma](https://onco.cc/cancers/uveal-melanoma/)
- fronts: [Devices & Physical Therapies](https://onco.cc/fronts/devices/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Isolated limb perfusion and infusion](https://onco.cc/technologies/isolated-limb-perfusion/), [Radioembolisation (TARE / SIRT, yttrium-90)](https://onco.cc/technologies/radioembolisation-tare/), [Transarterial chemoembolisation (TACE)](https://onco.cc/technologies/tace/)
- drugs: [Melphalan (including hepatic delivery system)](https://onco.cc/drugs/melphalan/), [Tebentafusp](https://onco.cc/drugs/tebentafusp/)
- trials: [An Open-Label Expanded Access Study of the Melphalan/Hepatic Delivery System (HDS) in Patients With Hepatic Dominant Ocular Melanoma](https://onco.cc/trials/nct05022901/), [FOCUS](https://onco.cc/trials/nct02678572/), [PHP in Combination With IPI1/NIVO3 Compared to IPI3/NIVO1 Only in Patients With Uveal Melanoma Liver Metastases](https://onco.cc/trials/nct06519266/)
- key papers: [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](https://onco.cc/key-papers/paper-zager-ann-surg-oncol/)
- terms: [Liver-directed therapy (TACE, TARE, HAI, ablation)](https://onco.cc/terms/liver-directed-therapy/)

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