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Annals of Oncology Advance Access originally published online on October 24, 2007
Annals of Oncology 2007 18(12):1995-1999; doi:10.1093/annonc/mdm405
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© 2007 European Society for Medical Oncology

gastrointestinal tumors

Hepatic arterial infusion plus systemic irinotecan in patients with unresectable hepatic metastases from colorectal cancer previously treated with systemic oxaliplatin: a retrospective analysis

D. J. Gallagher, M. Capanu, G. Raggio and N. Kemeny*

Memorial Sloan Kettering Cancer Center, New York, NY, USA

* Correspondence to: Dr Nancy Kemeny, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. Tel: +1 212-639-8068; Fax: +1 212-794-7186; E-mail: kemenyn{at}mskcc.org

Background: Response rates to systemic chemotherapy are low after tumor progression on oxaliplatin regimens. Hepatic arterial infusion (HAI) therapy in patients with tumor progression is a viable alternative.

Patients and methods: Thirty-nine heavily pre-treated patients (all receiving prior oxaliplatin) with unresectable colorectal hepatic metastases were treated with systemic CPT-11 and concurrent HAI floxuridine (FUDR) and dexamethasone (DEX).

Results: Partial responses were seen in 44% of patients. Median time to hepatic progression was 8.6 months, and median time to overall progression was 6.5 months. Median survival from time of initiation of HAI was 20.1 months [95% confidence interval (CI) 16.9–21.4] and from the initiation of treatment of metastatic disease, 32.01 months (95% CI 29.1–34.6). After a median follow-up of 19.1 months, seven patients (18%) proceeded to potentially curative surgery. Grade 3/4 toxic effects included neutropenia (13%), diarrhea (15%), intra-abdominal hemorrhage (2%), and bleeding duodenal ulcer (2%). Elevated liver function tests were seen, including bilirubin concentration >3 mg/dl (7%), alkaline phosphatase 2X baseline (20%), and aspartate aminotransferase >3X baseline (26%).

Conclusions: HAI FUDR/DEX plus systemic CPT-11 achieves a response rate of 44% and a median overall survival of 20 months in heavily pre-treated patients with colorectal hepatic metastases all receiving previous oxaliplatin; 18% of patients proceeded to surgical resection or ablation.

Key words: colorectal cancer, hepatic arterial infusion, irinotecan, metastatic, oxaliplatin

Received for publication April 18, 2007. Revision received July 6, 2007. Accepted for publication July 10, 2007.


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