Annals of Oncology 15:933-939, 2004
© 2004 European Society for Medical Oncology
Original Paper |
Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients
Received 25 September 2003; revised 28 January 2004; accepted 2 February 2004Background:
The aim of this study was to observe the effects of neoadjuvant therapy with irinotecan and 5-fluorouracil (5-FU)/folinic acid (FA) on the resection rate and survival of colorectal cancer patients with initially unresectable hepatic metastases.
Patients and methods:
Forty patients received neoadjuvant chemotherapy comprising irinotecan 180 mg/m2 administered intravenously (i.v.) on day 1, FA 200 mg/m2 i.v. on days 1 and 2, 5-FU 400 mg/m2 i.v. bolus on days 1 and 2, and 5-FU 1200 mg/m2 as a continuous 48-h i.v. infusion on day 1. The treatment was repeated every 2 weeks and response was assessed every 12 weeks (six cycles).
Results:
The objective response rate to chemotherapy was 47.5% (n = 19), with two complete responses and disease stabilization in 11 (27.5.%) patients. Responses were unconfirmed for 11 patients undergoing surgery within 2 weeks. Treatment was well tolerated and adverse events were typical of the chemotherapy agents used. Twenty-seven (67.5%) patients reported hematological toxicity (35.0% grade 3/4) and 14 (35.0%) reported gastrointestinal toxicity (12.5% grade 3/4). Thirteen patients (32.5%) underwent potentially curative liver resection following chemotherapy. Chemotherapy was particularly effective in patients with large metastases on entry to the study. The median time to progression is 14.3 months and, at a median follow-up of 19 months, all patients are alive.
Conclusions:
Neoadjuvant therapy with irinotecan combined with 5-FU/FA enabled a significant proportion of patients with initially unresectable liver metastases to undergo surgical resection. The effects of treatment on survival have yet to be determined.
1 Unit of Medical Oncology, Department of Internal Medicine and 2 Unit of Hepatobiliary Surgery, Department of General Surgery, Catholic University of Sacred Heart, Rome, Italy
Key words: colorectal, 5-fluorouracil, irinotecan, liver, neoadjuvant, unresectable
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. Zhao, J. Zhu, X. Ji, J. Cai, F. Wan, Q. Li, B. Zhong, S. Tucker, and D. Wang A Phase II Study of Irinotecan and Capecitabine for Patients with Unresectable Liver-only Metastases from Colorectal Cancer Jpn. J. Clin. Oncol., January 1, 2010; 40(1): 10 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. E. Kemeny, F. D. H. Melendez, M. Capanu, P. B. Paty, Y. Fong, L. H. Schwartz, W. R. Jarnagin, D. Patel, and M. D'Angelica Conversion to Resectability Using Hepatic Artery Infusion Plus Systemic Chemotherapy for the Treatment of Unresectable Liver Metastases From Colorectal Carcinoma J. Clin. Oncol., July 20, 2009; 27(21): 3465 - 3471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Nordlinger, E. Van Cutsem, T. Gruenberger, B. Glimelius, G. Poston, P. Rougier, A. Sobrero, M. Ychou, and on behalf of the European Colorectal Metastases Tr Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel Ann. Onc., June 1, 2009; 20(6): 985 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Alberts and L. D. Wagman Chemotherapy for Colorectal Cancer Liver Metastases Oncologist, October 1, 2008; 13(10): 1063 - 1073. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Adam, T. Aloia, F. Levi, D. A. Wicherts, R. J. de Haas, B. Paule, M.-P. Bralet, M. Bouchahda, D. Machover, M. Ducreux, et al. Hepatic Resection After Rescue Cetuximab Treatment for Colorectal Liver Metastases Previously Refractory to Conventional Systemic Therapy J. Clin. Oncol., October 10, 2007; 25(29): 4593 - 4602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Falcone, S. Ricci, I. Brunetti, E. Pfanner, G. Allegrini, C. Barbara, L. Crino, G. Benedetti, W. Evangelista, L. Fanchini, et al. Phase III Trial of Infusional Fluorouracil, Leucovorin, Oxaliplatin, and Irinotecan (FOLFOXIRI) Compared With Infusional Fluorouracil, Leucovorin, and Irinotecan (FOLFIRI) As First-Line Treatment for Metastatic Colorectal Cancer: The Gruppo Oncologico Nord Ovest J. Clin. Oncol., May 1, 2007; 25(13): 1670 - 1676. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Leichman Neoadjuvant Chemotherapy for Disseminated Colorectal Cancer: Changing the Paradigm J. Clin. Oncol., August 20, 2006; 24(24): 3817 - 3818. [Full Text] [PDF]
|
|
|
|
|
|
S. Benoist, A. Brouquet, C. Penna, C. Julie, M. El Hajjam, S. Chagnon, E. Mitry, P. Rougier, and B. Nordlinger Complete Response of Colorectal Liver Metastases After Chemotherapy: Does It Mean Cure? J. Clin. Oncol., August 20, 2006; 24(24): 3939 - 3945. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Poston, R. Adam, and J.-N. Vauthey Downstaging or Downsizing: Time for a New Staging System in Advanced Colorectal Cancer? J. Clin. Oncol., June 20, 2006; 24(18): 2702 - 2706. [Full Text] [PDF]
|
|
|
|
|
|
C. Garufi, G. M. Ettorre, B. Vanni, A. Torsello, and E. Terzoli Neoadjuvant Chemotherapy for Metastatic Colon Cancer: Too Much Caution and Still Too Much to Be Assessed J. Clin. Oncol., May 10, 2006; 24(14): 2217 - 2218. [Full Text] [PDF]
|
|
|
|
|
|
G. Chong and D. Cunningham Improving Long-Term Outcomes for Patients With Liver Metastases From Colorectal Cancer J. Clin. Oncol., December 20, 2005; 23(36): 9063 - 9066. [Full Text] [PDF]
|
|
|
|
|
|
G. J. Poston, R. Adam, S. Alberts, S. Curley, J. Figueras, D. Haller, F. Kunstlinger, G. Mentha, B. Nordlinger, Y. Patt, et al. OncoSurge: A Strategy for Improving Resectability With Curative Intent in Metastatic Colorectal Cancer J. Clin. Oncol., October 1, 2005; 23(28): 7125 - 7134. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Folprecht, A. Grothey, S. Alberts, H.-R. Raab, and C.-H. Kohne Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates Ann. Onc., August 1, 2005; 16(8): 1311 - 1319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. J. Petrelli, J. Abbruzzese, P. Mansfield, and B. Minsky Hepatic Resection: The Last Surgical Frontier for Colorectal Cancer J. Clin. Oncol., July 10, 2005; 23(20): 4475 - 4477. [Full Text] [PDF]
|
|
|
|
|
|
G. D. Leonard, B. Brenner, and N. E. Kemeny Neoadjuvant Chemotherapy Before Liver Resection for Patients With Unresectable Liver Metastases From Colorectal Carcinoma J. Clin. Oncol., March 20, 2005; 23(9): 2038 - 2048. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Delaunoit, S. R. Alberts, D. J. Sargent, E. Green, R. M. Goldberg, J. Krook, C. Fuchs, R. K. Ramanathan, S. K. Williamson, R. F. Morton, et al. Chemotherapy permits resection of metastatic colorectal cancer: experience from Intergroup N9741 Ann. Onc., March 1, 2005; 16(3): 425 - 429. [Abstract] [Full Text] [PDF]
|
|