Transarterial Chemoembolization for the Treatment of Uveal Melanoma With Liver Metastases

Prior treatment

• Previous liver-directed treatments including immunoembolization, chemoembolization, radioembolization, hepatic arterial perfusion, or drug-eluting beads
• Presence of life-limiting extrahepatic metastasis that requires systemic treatment within 3 months. However, radiation treatment of extrahepatic metastases such as bone, lymph nodes or subcutaneous metastases will be permitted while the patient is on study. Zometa or X-Geva to treat bone metastases will also be permitted. Immune check-point inhibitors while on study will NOT be permitted
• Uncontrolled severe bleeding tendency or active gastrointestinal (GI) bleeding due to varices or main portal vein occlusion. Abnormal coagulation test must be corrected prior to the procedure
• History of life-threatening allergic reaction to iodinated contrast or BCNU despite pre-treatment with steroids
• Presence of known untreated brain metastases. If patients have had previous treatment for brain metastasis, an MRI or CT of the brain must confirm the stabilization of the brain metastasis for more than 4 weeks
• Biliary obstruction, biliary stent, or prior biliary surgery including sphincterotomy but excluding cholecystectomy

Other illness

• Presence of uncontrolled hypertension or congestive heart failure, or acute myocardial infarction within 6 months of entry
• Presence of any other medical conditions that imply a survival of less than six months

Lab values

• Known active viral or autoimmune hepatitis requiring treatments with serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) equal or greater than 5 times normal

Age

• Less than 18 years of age

Other

• Portal vein occlusion, or inadequate collateral portal venous flow, as determined by MRI
• Pregnant and/or breastfeeding women

• Histologically confirmed metastatic uveal melanoma in the liver
• Tumor burden \< 75%. Patients must have at least one tumor measuring \>= 10 mm in longest diameter by magnetic resonance imaging (MRI) or triphasic computed tomography (CT) (if MRI is not available or contraindicated)
• No prior transarterial catheter-directed therapies. Prior hepatic tumor ablation, hepatic radiation or liver resection will be permitted as long as growing measurable liver tumors exists. Prior systemic treatments are allowed as long as there are no outstanding toxicities greater than grade 1
• Willingness and ability to give informed consent
• Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
• Serum creatinine =\< 2.0 mg/dl
• Bilirubin =\< 2.0 mg/ml. Exceptions will be made for patients with diagnosed Gilbert's Syndrome. In this instance, a bilirubin level =\< 3.0 mg/ml will be allowed for this patients with this syndrome
• Albumin \>= 3.0 g/dl
• No ascites
• Granulocyte count \>= 1500/m\^3
• Platelet count \>= 150,000/m\^3