Clinical

Hepatic arterial infusion improves survival in metastatic colorectal cancer

Last Updated: 2006-03-16 11:16:17 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Hepatic arterial infusion of chemotherapy offers better overall survival and response rates than does systemic therapy, according to a report in the March 20th issue of the Journal of Clinical Oncology.

"We have seen improved results with both newer systemic chemotherapeutic agents and hepatic arterial infusion," lead author Dr. Nancy E. Kemeny from Memorial Sloan-Kettering Cancer Center, New York told Reuters Health. Future research will involve determining when to use these various methods to treat liver tumors and how best to use them in combination with other therapy.

Dr. Kemeny and colleagues compared hepatic arterial infusion treatment with floxuridine, leucovorin, and dexamethasone and with fluorouracil and leucovorin in 135 patients with histologically confirmed colorectal carcinoma with unresectable liver metastases and no radiologic evidence of extrahepatic disease.

Overall survival was 24.4 months in the hepatic arterial infusion group, the authors report, compared with 20.0 months in the systemic treatment group, a significant improvement.

The two systemic drug arms did not differ in time to disease progression, the results indicate, but time to hepatic progression was longer in patients treated with hepatic arterial infusion. Multivariate analyses continued to show an overall survival advantage for the group treated with hepatic arterial infusion.

In the hepatic arterial infusion group, two patients had complete liver responses and 26 had partial responses (for a 47% response rate), the researchers note, compared with 14 partial responses (24%) in the systemic treatment group.

Neutropenia, diarrhea, and stomatitis occurred less often among hepatic arterial infusion patients than among systemic treatment patients, the report indicates, but hyperbilirubinemia was significantly more common among hepatic arterial infusion patients.

Physical functioning at 3 months and 6 months was better in the hepatic arterial infusion group than in the systemic therapy group, the investigators observed, but there were no differences in other measures of quality of life, including social functioning, role functioning-emotional or general health perception.

"Since this multi-institutional trial, the options available to oncologists and their patients have blossomed," Dr. Kemeny said. "Aside from the newer cytotoxic agents, there is also exciting work being done with drugs that inhibit vascular endothelial growth factor and epidermal growth factor receptors, as well as the use of attenuated viral agents."

"Since this trial, we have used combinations of systemic chemotherapy added to hepatic arterial infusion and have produced even better response and survival rates," Dr. Kemeny added. "Lately we have also explored the use of hepatic arterial infusion therapy for patients with primary hepatic malignancies."

J Clin Oncol 2006;24.