Melphalan chemosaturation with percutaneous hepatic artery perfusion and hepatic vein isolation for primary or metastatic cancer in the liver

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 11 sources, which was discussed by the committee. The evidence included 1 randomised controlled trial, 1 non‑randomised comparative study and 9 case series (including 2 studies looking at the same patient population). It is presented in table 2 of the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The committee considered the key efficacy outcomes to be: overall survival, progression‑free survival, quality of life and downstaging of cancer.

The committee considered the key safety outcomes to be: procedure-related complications (including bleeding, thrombosis and cardiovascular events), bone marrow or haematological toxicity, and death.

NICE received 1 submission from a patient organisation.

The committee noted that the toxicity of the procedure is principally related to how efficiently the melphalan is removed and prevented from entering the systemic circulation.

The technology has changed over time, and the newest filter may be associated with less haematological toxicity.

The procedure is used for unresectable liver cancer.