First-Time Use of Hepzato Kit at UCLA Santa Monica Medical Center

Q&A with Dane Saksa, MD, MBA, and Micaela Zywicki, MD

Q: Can you tell us about the recent Hepzato Kit procedure performed at UCLA?

The Hepzato Kit procedure was performed at UCLA recently, marking the first time it was utilized at our hospital and only the second time the procedure has ever been performed in the U.S. since receiving FDA approval. This procedure is aimed at treating patients with liver metastasis from uveal melanoma, which is a particularly rare form of cancer with a very poor prognosis by the time metastasis to the liver has occurred.

Q: What exactly is Hepzato and what does it entail?

Hepzato is a novel therapeutic approach designed for patients with terminal uveal melanoma that has metastasized to the liver. It involves a unique method of isolating the circulation to the liver (essentially IVC clamping), delivering a high dose of chemotherapy directly to the affected area, and then filtering and returning the cleansed blood back to the patient via a veno-venous bypass circuit. The goal is to extend survival significantly, with some patients now surpassing two years post-treatment.

Q: What is the significance of this procedure for patients with liver metastasis from uveal melanoma?

Liver metastasis from uveal melanoma typically carries a very poor prognosis, with few effective treatment options available. Many patients, otherwise healthy apart from the liver metastasis, face survival rates of around six months. The introduction of the Hepzato Kit represents a cutting-edge and promising development in addressing this challenging condition.

Q: Could you elaborate on the results seen with the Hepzato Kit?

The Hepzato Kit received FDA approval in August 2023 specifically for this indication, following promising trial outcomes that demonstrated prolonged survival rates from an average of 6 months to 14 months for responders.

Q: What does the procedure entail and how is it conducted?

The procedure itself is quite complex and requires extensive collaboration across multiple departments including Anesthesiology, Pharmacy, Perfusion, Post-Anesthesia Care Unit/Critical Care, and Interventional Radiology. It is a minimally invasive approach involving the infusion of melphalan directly into the hepatic artery in the setting of complete balloon occlusion of the IVC to isolate the hepatic circulation. The blood is then circulated through a special circuit to cleanse it of chemotherapy agents before being returned to the patient. The entire process typically takes about three hours, with patients often discharged the following day.

Q: How does anesthesiology contribute to the success of this procedure?

Anesthesiology plays a crucial role in managing the hemodynamic changes associated with this procedure, which are profound to say the least. Dr. Dane Saksa and the anesthesiology team are tasked with closely monitoring the patient's condition moment by moment to ensure safety and efficacy throughout and correcting the expected coagulopathies prior to extubation.

Q: Can you share how many upcoming procedures are scheduled at UCLA?

As of May 13, 2024, we have now completed 4 cases, and have the first repeat patient coming back for treatment in June.

Q: What are your personal takeaways from being part of this groundbreaking procedure?

Dr. Zywicki: Being involved in the Hepzato Kit procedure was truly one of the highlights of my residency. Witnessing the collaborative effort and the potential impact on patient outcomes has been immensely rewarding.

Dr. Saksa: Building out this groundbreaking process with a dedicated interdisciplinary team has been inspiring – with good communication and a committed team, anything is possible, even in non-OR settings