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Annals of Oncology Advance Access published online on October 24, 2007
Annals of Oncology, doi:10.1093/annonc/mdm405
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© 2007 European Society for Medical Oncology

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.

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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