Despite major advances in systemic therapies, outcomes for patients with metastatic uveal melanoma remain poor. Since up to 90% of patients develop liver metastases, the liver has become the primary target for locoregional treatment strategies. This lecture will review the evolution and future of these approaches, focusing on isolated hepatic perfusion (IHP) and percutaneous hepatic perfusion (PHP). Data from registry studies, randomized controlled trials such as SCANDIUM, and the recent FOCUS trial highlight the capacity of locoregional therapy to provide meaningful benefits. Emerging evidence also indicates that regional treatments may trigger immunogenic cell death, creating opportunities for rational combinations with systemic immunotherapy. Recent trials, including CHOPIN and SCANDIUM III, are evaluating the safety and efficacy of combining PHP with immune checkpoint inhibitors, with endpoints spanning survival, progression, quality of life, and biomarker discovery. Together, these efforts are redefining the role of locoregional therapy from liver-directed palliation toward integrated multimodal treatment, with the potential to extend survival in patients beyond what is achievable with systemic therapy alone.
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