UVA Health Becomes First in Virginia to Offer Hepzato for Uveal Melanoma with Liver Metastases
Key Insights
UVA Health (search) is the first health system in Virginia to offer Hepzato, a liver-directed chemotherapy delivery system for uveal melanoma (search) that has metastasized to the liver.
Hepzato uses percutaneous hepatic perfusion to isolate the liver's blood supply, delivering high-dose melphalan while filtering blood to limit systemic toxicity.
The FDA-approved treatment can be repeated up to six times every six to eight weeks, with the goal of containing disease and extending survival rather than achieving a cure.
UVA Health (search) has become the first health system in Virginia to offer Hepzato, a novel liver-directed therapy for patients with uveal melanoma (search) that has spread to the liver, the health system announced during a July 10 media briefing. The treatment, developed by Delcath Systems (search) and approved by the Food and Drug Administration in 2023, represents a new option for patients facing a cancer with historically limited therapeutic choices once it metastasizes beyond the eye.
UVA Health (search) interventional radiologist Dr. Daniel Sheeran and cardiac anesthesiologist Dr. Paul Gallo led the effort to bring Hepzato to the institution. "Dr. Sheeran and I are really proud to help bring this therapy here to Virginia, [and to be] the first in the state," Gallo said. "We've done additional training to really make sure that this is the best experience possible."
A Distinct Form of Melanoma (search) with Few Options
Uveal melanoma (search) arises from melanocytes in the uvea, the middle layer of the eye, making it both an eye cancer and a melanoma (search) distinct from its cutaneous counterpart. "It does act a little bit differently than what many people may think of when they think about melanoma," Sheeran said. "It is nonetheless still the most common diagnosis of a primary eye cancer in adults."
According to Sheeran, more than 100,000 new melanoma (search) diagnoses occur in the United States each year, though only a small fraction are uveal. Approximately 50% of uveal melanomas will metastasize, and roughly 90% of those metastases involve the liver, making hepatic control a central clinical challenge.
Treatment options narrow considerably once the cancer spreads. Systemic therapies delivered intravenously are available, but Sheeran noted their response rates are suboptimal. One targeted medication, Kimmtrak, is restricted to the small subset of patients whose tumors carry the specific mutation the drug targets. "Some have theorized that the number of quote unquote mutations within this tumor is not as many as other tumors … so our ability to then target said mutations is a bit limited," Sheeran explained.
How Hepzato Works
Hepzato employs percutaneous hepatic perfusion, a minimally invasive procedure that isolates the liver's blood supply to deliver high concentrations of the chemotherapy drug melphalan directly to the affected organ. The blood exiting the liver is then filtered before returning to systemic circulation, thereby limiting toxicity to other organs.
"We're able to isolate the blood flow to the liver to allow us to deliver the medication, and then we also isolate the blood flow out of the liver to then filter the medication and return the blood to the body," Sheeran said.
The procedure uses small needles and tubes rather than large incisions. Sheeran compared the tubing size to the "tip of a pen," with the tube threaded through blood vessels to reach the liver. The entire procedure takes approximately four hours, though the medication delivery itself occurs in far less time, with the majority of the window devoted to set-up. Patients spend one night in the intensive care unit for observation, allowing the team to confirm blood levels return to normal and to remove the tubes safely.
Under FDA approval, the treatment can be repeated up to six times, spaced six to eight weeks apart, with physicians monitoring patient tolerance and tumor response between cycles.
A Multidisciplinary Team Approach
Delivering Hepzato requires coordinated expertise across multiple specialties. The team includes an interventional radiologist, an anesthesiologist, a perfusion team operating the chemotherapy delivery and filtration machine, as well as pharmacy and nursing staff. Patients receive general anesthesia and are fully asleep during the operation.
"As an anesthesiologist, my role in all of this is to help this patient safely and comfortably undergo this procedure," Gallo said. "We see that our role as anesthesiologists is to really provide safe, compassionate care, on these big days for folks."
Patient Selection and Treatment Goals
Not every patient with uveal melanoma (search) qualifies for Hepzato. Sheeran described a "Goldilocks period" — a window when the cancer has spread within the liver but has not yet overtaken the organ or moved beyond it. Oncologists on the multidisciplinary team evaluate whether the therapy is appropriate, weighing potential benefits against known side effects.
"We want to make sure we take the risk in the right patient at the right time as a team approach," Sheeran said. "We're looking to, with this new therapy, be very focal, and while there are some side effects, [we] also [want to] try to mitigate those in the long term."
The goal of Hepzato is containment rather than cure. "We know we can't cure cancer in this setting," Sheeran said. "But we can get a response within the liver and help people live longer and hopefully [have a] better quality of life."
Sheeran emphasized that patients with uveal melanoma (search) should maintain regular follow-up appointments with their ophthalmologist and oncologist, as the tumor has a predisposition to recur even many years after treatment. Early detection of recurrence allows physicians to offer therapy when it is most appropriate.
Looking Forward
Gallo noted that Hepzato is currently under investigation in clinical trials for other cancer types, with results anticipated in the coming years. Because patients return for repeat treatments, the care team develops ongoing relationships with them over the course of therapy.
"[The] real joy of being part of this team is building those relationships with patients," Gallo said. "[To see] them really continue to live their lives and [feel] like we're offering a new innovative treatment to the community and trying to make the world just a little bit of a better place."