When we saw such a dramatic response with limb perfusion, it inspired us to say that we could really make an impact on survival with this if the same responses held up in the liver. Although the liver is potentially responsive to an isolated perfusion treatment, the procedure is more complicated than with a limb. Up to seven hours of surgery are required to perform the liver procedure, and unlike the limb perfusion, this treatment is still considered experimental and not covered by third party payers. Nevertheless, Fraker is hopeful. A Phase II clinical trial is now underway for patients with liver-only disease who have exhausted all standard treatment options.
Several patients have no signs of regrowth after more than a year.
A current trial adding an arterial infusion pump may further boost response rates. Researchers are also comparing liver perfusion done in Europe with melphalan alone to their results using TNF combined with melphalan. Fraker is optimistic that this technique offers hope to patients with liver disease and will have further ramifications for cancer treatment in the future. A former colleague at the National Cancer Institute is studying the application of TNF-isolated perfusion in the lung. Fraker pointed out that the lung and the liver are organs that are amenable to near complete vascular isolation and are also major repositories of metastatic disease.