Hepatic chemosaturation therapy

Dr Krishna Kandarpa – Delcath Systems Inc. and Dr Pier Ferrucci – European Institute of Oncology, Milan, Italy
Interviewed by Dr Linda Cairns, ecancer

LC: Hepatic chemosaturation therapy, can you explain what this is, this new technique?

KK: Sure, it’s a method by which we isolate the liver and we’re able to give concentrated treatment to the liver alone. We call it isolated hepatic profusion in the surgical arena but that was a one-time procedure only. So we’ve developed a percutaneous alternative to it where we can isolate the liver, give the drug directly into the arterial system, our drug is melphalan hydrochloride, then we capture the blood coming out of the liver on the venous side, we take it out of the body, filter it and we return the blood which has essentially a much less concentration of drug back into the body.

LC: And so, Dr Ferrucci, you are the lead investigator in the first centre in Europe to be doing this type of therapy, what are the advantages of this for somebody with liver metastases?

PF: From a clinical point of view the advantages are many in the sense that we can deliver the high dose chemotherapy to the whole organ and this is a novel procedure that helps to treat older patients that have a disease mainly limited to the liver. The other advantage is that treating the whole organ, you are able to treat also the micrometastases which usually are not seen by the methods able to evaluate the liver and we are in the condition of creating new opportunities to treat our patients and to create a bridge with other treatments in the sense that we have more opportunity to expand the windows of the options, the treatments, and with the basic possibility to expand the expectancies of our patients.
 

LC: I imagine one of the positive effects is that you reduce the systemic side effects in giving the drug systemically?

PF: Yes, exactly. This is one of the main points, we can deliver high dosages of melphalan, which is a drug that affects many kinds of neoplasia, with few toxicities to the liver and filtering the drug we can avoid systemic toxicity.

KK: One of the advantages of the procedure is that it’s repeatable; I mentioned the surgical procedure which was not. So this can be actually offered like cyclical therapy like you would chemotherapy except it’s focussed on one organ and gives you the opportunity to treat lesions elsewhere with other methods, if you like.

LC: So what is the future for this treatment?

KK: We actually have a very active preclinical programme and we’re developing filters for other drugs for other applications. We’re also looking at the cell line; we usually start with cell line work to see sensitivities of tumours and then when see that certain drugs are very effective we then move on to developing specific filters for those drugs because each filter has to be designed for a particular drug. We’re looking at applications, for example, in colorectal carcinoma, hepatocellular carcinoma; we have some preliminary work that has already been done with the IHP that gives us some very encouraging signals that that’s the direction we should head.

LC: And, as I said, the European Institute of Oncology is the first centre in Europe but there are some other centres that are in Europe.

KK: Yes there are. We also have the Wolfgang Goethe Institute in Frankfurt, the IGR in Paris, the University Hospital in Southampton in the UK and Galway Hospital in Ireland. We’ve done about twenty procedures in the past few months among these.

LC: So what is your experience of treating these patients?

PF: We treated patients affected by melanoma, by colorectal cancer and they all have mainly liver metastases and they have a good feeling with the procedure in the sense that we have good results and low toxicity. We demonstrated that it’s really possible to control the disease and to offer this new option to many of them. We treated melanoma mainly from ocular origin because it’s one of the diseases that involve mainly the liver but it’s useful and effective also for the colorectal cancer and maybe also for the NET tumours which are being treated in previous clinical trials with this procedure. There is much more a field of evaluation for other kinds of tumours like hepatocellular carcinoma which starts and lives in the liver only.

LC: OK, thank you.