Abstract
This study was designed to determine response rate, survival and toxicity associated with combination chemotherapy delivered intra-arterially to liver in patients with hepatic metastases of colorectal origin refractory to standard systemic treatment. A total of 28 patients who failed prior systemic treatment with fluoropyrimidines received a median of 5 cycles of intra-arterial treatment consisting of 5-fluorouracil 700 mg/m2/d, leucovorin 120 mg/m2/d, and cisplatin 20 mg/m2/d for 5 consecutive days. Cycles were repeated at intervals of 5–6 weeks. A major response was achieved in 48% of patients: complete response in 8% and partial response in 40%. The median duration of response was 11.5 months. Median survival was 12 months at a median follow up of 12 months. On multivariate analysis, the only variables with a significant impact on survival were response to treatment and performance status. Toxicity was moderate: grades III–IV neutropenia occurred in 29% of patients. Most of the patients complained of fatigue lasting for a few days following each cycle. There were no cases of hepatobiliary toxicity. These findings indicate that regional intra-arterial treatment should be considered in selected patients with predominantly liver disease following failure of standard treatment. © 2001 Cancer Research Campaign http://www.bjcancer.com
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References
Advanced Colorectal Cancer Meta-Analysis Project (1992) Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response rate. J Clin Oncol 10: 896–903
Cantrell JE Jr, Hart RD, Taylor RF and Harvey JH Jr (1987) Pilot trial of prolonged continuous infusion 5-fluorouracil and weekly cisplatin in advanced colorectal cancer. Cancer Treat Rep 71: 615–618
Chang AE, Schneider PD, Sugarbaker PH, Simpson C, Culnane M and Steinberg SM (1987) A prospective randomized trial of regional versus systemic continuous 5-FUDR chemotherapy in the treatment of colorectal liver metastases. Ann Surg 206: 685–693
Cox DR (1972) Regression models and life tables. J Roy Stat Soc 34: 187–220
Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P, Jandik P, Iveson T, Carmichael J, Alakl M, Gruia G, Awad L and Rougier P (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355: 1041–1047
Ensminger WD and Gyves JW (1983) Clinical pharmacology of hepatic arterial chemotherapy. Semin Oncol 10: 176–183
Foster HJH and Berman MM (1977) Solid liver tumors. Ebert PA (ed) Major Problems in Clinical Surgery pp. 209–234, W.B. Saunders: Philadelphia
Harmantas A, Rotstein LE and Langer B (1996) Regional versus systemic chemotherapy in the treatment of colorectal carcinoma metastatic to the liver. Cancer 78: 1639–1645
Hohn DC, Stagg RJ, Friedman MA, Hannigan JF, Rayner A, Ignoffo RJ, Acord P and Lewis BJ (1989) A randomized trial of continuous intravenous versus hepatic intraarterial floxuridine in patients with colorectal cancer metastatic to the liver: the Northern California Oncology Group Trial. J Clin Oncol 7: 1646–1654
Kaplan E and Meier P (1958) Nonparametric estimation for incomplete observations. J Am Stat Assoc 53: 457–481
Kemeny N, Conti JA, Cohen A, Campana P, Huang Y, Shi WJ, Botet J, Pulliam S and Bertino JR (1994) Phase II study of hepatic arterial floxuridine, leucovorin, and dexamethasone for unresectable liver metastases from colorectal carcinoma. J Clin Oncol 12: 2288–2295
Kemeny N, Daly J, Reichman B, Geller N, Botet J and Oderman P (1987) Intrahepatic or systemic infusion of FUDR in patients with liver metastases from colorectal carcinoma. A randomized trial. Ann Intern Med 107: 459–465
Kemeney N and Ron I (1999) Hepatic arterial chemotherapy in metastatic colorectal patients. Semin Oncol 26: 524–535
Kemeny N and Seiter K (1993) Treatment options for patients with metastatic colorectal cancer. Niederhuber JE (eds). Current Therapy in Oncology pp. 447–457, Mosby Year-Book: St Louis
Landis SH, Murray T, Bolden S and Wingo PA (1998) Cancer statistics, 1998. CA Cancer J Clin 48: 6–29
Meta-Analysis Group in Cancer Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer (1996) J Natl Cancer Inst 88: 252–258
Palmeri S, Gebbia V, Russo A, Gebbia N, Rostum Y and Rausa L (1992) Cisplatinum in combination with 5-fluorouracil and citrovorum factor in the treatment of advanced colorectal carcinoma. Cancer Invest 10: 497–504
Patt YZ, Hoque A, Lozano R, Pazdur R, Chase J, Carrasco H, Chuang V, Delpassand ES, Ellis L, Curley S, Roh M and Jones DV (1997) Phase II trial of hepatic arterial infusion of fluorouracil and recombinant human interferon alpha-2b for liver metastases of colorectal cancer refractory to systemic fluorouracil and leucovorin. J Clin Oncol 15: 1432–1438
Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J and Smith PG (1977) Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 35: 1–39
Pitot HC, Wender DB, O'Connell MJ, Schroeder G, Godlberg RM, Rubin J, Mailliard JA, Knost JA, Ghosh C, Kirschling RJ, Levitt R and Windschitz HE (1997) Phase II trial of irinotecan in patients with metastatic colorectal carcinoma. J Clin Oncol 15: 2910–2919
Rougier P, Bugat R, Douillard JY, Culine S, Suc E, Brunet P, Becouarn Y, Ychou M, Marty M, Extra JM, Bonneterre J, Adenis A, Seitz JF, Ganem G, Namer M, Conroy T, Negrier S, Merrouche Y, Burki F, Mousseau M, Herait P and Mahjoubi M (1997) Phase II study of irinotecan in the treatment of advanced colorectal cancer in chemotherapy-naive patients and patients pretreated with fluorouracil-based chemotherapy. J Clin Oncol 15: 250–260
Schabel FM, Trader MW, Laster WR, Corbett TH and Griswold DP Jr (1979) Cis-platinum: combination chemotherapy and cross-resistant studies with tumors of mice. Cancer Treat Rep 63: 1459–1473
Scheithauer W, Rosen H, Schiessel R, Schuller J, Karall M, Ernst F, Sebesta C, Kornek J, Hentschel E and Marczel A (1991) Treatment of patients with advanced colorectal cancer with cisplatin, 5-fluorouracil and leucovorin. Cancer 67: 1294–1298
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Cyjon, A., Neuman-Levin, M., Rakowsky, E. et al. Liver metastases from colorectal cancer: regional intra-arterial treatment following failure of systemic chemotherapy. Br J Cancer 85, 504–508 (2001). https://doi.org/10.1054/bjoc.2001.1972
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DOI: https://doi.org/10.1054/bjoc.2001.1972
