Ep 33: Percutaneous Hepatic Infusion for Uveal Melanoma

Summary Warning: we recorded ANOTHER 40-minute episode on uveal melanoma! But this time we decided *not* to split it into 2 episodes. So dig in for a long one...there's the use of props at the end! In this conversation, James and Sapna discuss the FOCUS trial and the use of the melphalan hepatic delivery system. The discussion highlights the importance of understanding the differences between infusion and perfusion, the implications of study design on dropout rates, and the future directions for treatment in this area. Takeaways The FOCUS trial showed a high dropout rate due to unappealing control arms. Melphalan hepatic delivery is a new approach for treating uveal melanoma. Understanding the difference between infusion and perfusion is crucial for treatment efficacy. Patient selection is key, especially regarding liver involvement. The objective response rate of 36.3% is significant for this patient population. Quality of life post-treatment has improved compared to previous methods. The study design faced challenges due to high dropout rates. Future studies may need to consider alternative endpoints for efficacy. The treatment requires a specialized care team for administration. Overall survival data is still pending for the new treatment approach. Keywords melphalan, HDS, uveal melanoma, FOCUS trial, treatment efficacy, patient selection, infusion, perfusion, clinical trials, oncology Sound Bites "This is a pitiful fact check." "The hazard ratio for that study for OS was basically one." "It's not a closed system of catheters." Chapters 00:00 Introduction and Icebreaker 02:31 Overview of the FOCUS Trial 05:09 Designing Clinical Trials with Challenging Control Arms 08:50 Procedure and Treatment Details 18:30 Objective Response Rate and Duration of Response 20:49 Side Effects and Considerations for Patient Selection 33:24 Fact Check 34:07 Dropout in the FOCUS Trial and the Checkmate 037 Study 36:47 Infusion versus Perfusion - what's the difference 39:54 Clarifying the M Category for Melanoma