INCLUSION CRITERIA:
Histologically or cytologically proven measurable primary hepatocellular or cholangiocarcinoma, metastatic ocular melanoma, or metastatic islet cell tumors, or other neuroendocrine tumors such as carcinoid tumors. Patients with colorectal adenocarcinoma limited to the parenchyma of the liver with no evidence of unresectable extrahepatic disease by preoperative radiological studies will be eligible.
Patients with colorectal cancer previously treated with intrahepatic arterial infusion therapy, those with aberrant arterial anatomy such that infusional therapy is not possible, or those with limited extrahepatic disease such that regional therapy is not indicated will be eligible for this protocol. Limited resectable extrahepatic disease includes an untreated asymptomatic primary tumor, malignant periportal lymph nodes, or a single site of hematogenous metastasis to a site such as lung or ovary.
Patients must have had no chemotherapy, radiotherapy, or biologic therapy for their malignancy in the month prior to the liver perfusion and must have recovered from all side effects.
Patients must have an ECOG performance standard of 0, 1 or 2 on the day prior to treatment.
Patients must have adequate hepatic function as evidenced by bilirubin less than 2.0 mg/dL (except in patients with Gilbert's Syndrome who must have a total bilirubin less than 3.0 mg/dl) and a PT less than or equal to 2 seconds of the upper normal limit Elevations in serum transaminases that are not due to hepatitis are acceptable.
Patients must be greater than 30 kg and 18 years of age or older.
Patients must have a platelet count greater than 100,000, a Hct greater than 27.0, a white blood count greater than or equal to 2,500/microliter, and a creatinine less than or equal to 1.5 mg/dL or a creatinine clearance of greater than 60 ml/min.
Patients must be aware of the neoplastic nature of his/her illness, the experimental nature of the therapy, alternative treatments, potential benefits, and risks. The patient must be willing to sign an informed consent.
EXCLUSION CRITERIA:
Pregnant patients and nursing mothers will be excluded.
Patients taking immunosuppressive drugs or on chronic anticoagulation will not be eligible.
Patients with active infections are not eligible.
Patients with biopsy proven cirrhosis or evidence of significant portal hypertension by history, endoscopy, or radiologic studies will be excluded.
Patients with a history of congestive heart failure with an LVEF less than 40 percent will be excluded.
Patients with COPD or other chronic pulmonary disease with PFT's less than 50 percent predicted for age will be excluded.
Patients with a history or diagnosis of VOD will be excluded.
Patients with chronic active hepatitis based on a positive serology test for surface antigen B or C will be excluded if there is evidence of cirrhosis on pathology. If no pathology specimen exists then evidence for cirrhosis will be determined based radiological studies and physical examination. If there are no indications of it then the patient will be registered on study and a biopsy will be obtained at the time of lapartomy for IHP with the expectation that occult clincally significant cirrhosis is very unlikely. If cirrhosis is pathologically confirmed the patient will not undergo treatment and be taken off study. Patients with radiographic or other signs of cirrhosis will undergo percutaneous biopsy prior to registration.
Warren Grant Magnuson Clinical Center (CC)