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Concentrated chemo shows success with liver cancer

A new, concentrated chemotherapy treatment for people with primary liver cancer or ocular melanoma, a rare cancer of the eye, has saved the life of at least one woman and may eventually help colon cancer and other survivors whose cancer spreads to the liver.

Dr. Richard Alexander, a surgical oncologist at the Greenebaum Cancer Center at the University of Maryland, worked on the treatment at the National Institutes of Health. The chemo targets melanoma that has metastasized to the liver.

Linda Campbell of Lexington, North Carolina, was diagnosed with ocular melanoma, a rare cancer, and endured many treatments to save her eye, according to a CNN story. Two years ago, after dealing with one recurrence, Campbell thought she had beaten cancer. Last year, though, she had a setback: she had lesions on her liver. Her melanoma had spread.

Campbell's liver was riddled with cancer; doctors were unable to count how many spots she had.

As her prognosis was poor, she entered an experimental treatment that directs an extremely high dose of chemotherapy to wherever cancer is growing.

Called percutaneous hepatic perfusion, or PHP, it uses a chemo dose 10 times stronger than patients could normally tolerate. Using specially designed catheters and filters to apply the drug only to the liver, PHP decreases the chance of damaging other organs and minimizes potential side effects.

Patients can tolerate this method because the liver is resilient, Alexander told CNN. The liver, unlike other organs, can withstand huge blasts of chemotherapy. Doctors also seal off some vessels stemming from the liver and flowing to the rest of the body, then filter the chemo outside the body. The liver is the only organ getting the poison, which usually kills healthy and cancerous cells.

Those in treatment get a drug, Melphalan, for 30 minutes every four weeks, in an operating room while the patient is under anesthesia. A catheter containing the drug is threaded up a major artery in the patient's groin into the liver's main artery. The major vein behind the liver receives a second catheter, and balloons on the catheter are inflated to direct all blood flowing from the liver into a filter outside the body. The filter removes almost 90 percent of the chemo from blood, and the blood is returned to the patient via a catheter in a major neck vein.

"This technique involves only a couple of small holes (in the skin) to place the catheters, so patients generally recover quickly and are released from the hospital in a day or two," said Dr. Fred Moeslein, a radiologist at the University of Maryland School of Medicine who does the treatment.

As with any chemo, side effects may include fatigue and lower red and white blood cell counts. Most patients can have four to six treatments.

PHP is an important development because people with Campbell's cancer typically don't live long after diagnosis. Just under 70,000 new cases of melanoma will be discovered this year in the U.S., estimated the American Cancer Society. Melanoma isn't the most common skin cancer, but it's the most fatal.

About 2,500 new cases of ocular melanoma are diagnosed each year. The cancer is often deadly if it spreads to the liver, which is the most common place for it to travel.

"Once melanoma - in particular ocular melanoma - has spread to the liver, it can be very aggressive and extremely difficult to treat," Alexander told CNN. "Patients really don't have a lot of options, so we're very hopeful that this new targeted chemotherapy will prove to be effective."

Initial results look promising. "Half of the people in the phase one study had their tumors shrink as a result of the treatment," said Alexander. "In some, the tumors have disappeared altogether."

Campbell has concluded her treatments; only a few spots remain on her liver. Her doctors are confident that they can treat them with traditional therapy.

The University of Maryland Medical Center is one of 13 sites conducting phase three trials on PHP. The study is headed by the National Cancer Institute. H. Lee Moffitt Cancer Center and Research Institute in Tampa is the only Florida site.

For the full list, visit http://www.livercancertrials.com.

Posted on Monday, July 13, 2009 at 04:26PM by Registered Commenter[Your Name Here] | CommentsPost a Comment

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