Whole-Liver Regional Chemotherapy: A New Era in Hepatobiliary Oncology

In a major milestone for cancer care in the region, UT Southwestern Medical Center has become the first institution in Texas and surrounding states to successfully administer Hepzato, a novel liver-directed chemotherapy treatment for metastatic uveal melanoma—a rare and aggressive eye cancer known for its high rate of liver metastasis.

The landmark procedure, performed this week on a 72-year-old patient with multifocal liver tumors, involved a cutting-edge method called percutaneous hepatic perfusion (PHP). This approach delivers concentrated doses of melphalan—a DNA-damaging chemotherapy agent—directly to the liver via the hepatic artery, while filtering the blood to minimize systemic toxicity.

Approved by the FDA in 2023, Hepzato represents a significant advance for patients with metastatic uveal melanoma, up to 90% of whom experience tumor spread to the liver. Hepzato’s PHP delivery system relies on a network of balloon catheters and an extracorporeal filtration circuit. During treatment, the patient’s liver is temporarily isolated from the rest of the circulatory system. After the catheter placement, melphalan is infused into the hepatic artery over a 30-minute period while the blood exiting the liver is diverted and filtered to remove residual chemotherapy before being returned to the body. The highly targeted technique allows for whole-liver treatment, unlike traditional liver-directed therapies that only target a single segment.

Patient eligibility is carefully evaluated through a multidisciplinary process. In this case, the patient’s physical fitness, liver function, and tumor burden—less than 50% liver involvement—made him an ideal candidate. Patients typically recover quickly, often returning to normal activity within 48 hours, and can receive up to six treatments spaced six to eight weeks apart.

Uveal melanoma accounts for just 5% of all melanomas in the U.S., but it carries a high risk of delayed metastasis—sometimes years after initial treatment. The eye tumor's unique biology and preference for liver spread make it particularly challenging to treat once metastasized.

The approval of Hepzato followed the FOCUS trial, a multicenter phase three study that demonstrated tumor shrinkage in 36.3% of patients and complete response in 7.7%. After one year, 80% of trial participants were still alive, and nearly two-thirds were progression-free at six months.

Access to Hepzato remains limited, as the treatment is subject to a Risk Evaluation and Mitigation Strategy (REMS) program, with fewer than three dozen centers across the country currently offering it. UT Southwestern is now among this small, elite group—and has plans to expand access further.

Key Takeaways:

• What’s new? Institutional adoption of whole‑organ hepatic perfusion enables organ‑level chemotherapy delivery for multifocal liver metastases.
• Who’s affected? Patients with liver‑predominant metastatic uveal melanoma and multidisciplinary teams at centers establishing perfusion programs.
• What changes next? Protocolized selection criteria, peri‑procedural pathways, and prospective outcome tracking should be established while contributing case data to broader comparative efforts.