Marked variability of melphalan plasma drug levels during regional hyperthermic isolated limb perfusion

Tsung Yen Cheng, Elizabeth Grubbs, Omar Abdul-Wahab, Szu Yun Leu, Chen Fang Hung, William Petros, Thomas Aloia, Randy Fedrau, Scott Pruitt, Michael Colvin, Henry Friedman, Douglas Tyler

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background: Hyperthermic isolated limb perfusion (HILP) with melphalan as treatment for locally recurrent or in-transit malignant melanoma is frequently performed but the principle for calculating drug dosage remains poorly understood. Methods: This study examined the pharmacokinetic profile of 14 consecutive patients to determine what variables were associated with toxicity and tumor responses. Results: Marked fourfold variability was noted in patient plasma melphalan concentrations. We defined a factor - the ratio of estimated limb volume (Vesti) to melphalan volume of distribution (Vss), Vesti/Vss - that was much more strongly correlated with acute regional toxicity than either area under concentration-time curve or peak plasma concentration. In addition, we found that AUX2 was the best correlate of tumor response. Conclusions: Pharmacokinetic evaluation of prospective HILP trials is critical to not only understand response and toxicity outcomes but also to potentially improve the therapeutic index of regional perfusion.

Original languageEnglish (US)
Pages (from-to)460-467
Number of pages8
JournalAmerican Journal of Surgery
Issue number5
StatePublished - Nov 2003
Externally publishedYes


  • Limb perfusion
  • Melanoma
  • Melphalan
  • Pharmacokinetics
  • Volume of distribution

ASJC Scopus subject areas

  • Surgery


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