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Phase I trial of hepatic arterial infusion (HAI) of floxuridine with modified oxaliplatin, 5-fluorouracil and leucovorin (m-FOLFOX6) in Chinese patients with unresectable liver metastases from colorectal cancer

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Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To determine the maximum tolerated dose (MTD) and preliminary efficacy of concurrent hepatic arterial infusion (HAI) of floxuridine (FUDR) and systemic modified oxaliplatin, 5-fluorouracil and leucovorin (m-FOLFOX6) in Chinese patients with unresectable hepatic metastases from colorectal cancer.

Patients and methods

Thirty-five patients with unresectable liver metastases with or without extrahepatic disease were treated with concurrent HAI and systemic m-FOLFOX6. HAI FUDR was delivered in a 14-day infusion with escalating dose levels, and each cycle was repeated every 4 weeks.

Results

The MTD for FUDR was 0.12 mg/kg/day when combined with systemic m-FOLFOX6. The dose-limited toxicities were neutropenia (8.6 %), alanine aminotransferase/aspartate aminotransferase elevation (5.7 %) and diarrhea (11.4 %). The overall response rate was 68.6 % for hepatic metastases and 14.3 % for extrahepatic metastases. The median progression-free survival and overall survival were 8.23 and 25 months, respectively.

Conclusion

The recommended dose of FUDR was 0.12 mg/kg/day when combined with systemic m-FOLFOX6. This combination achieved a high response rate in hepatic disease and a high control rate in extrahepatic disease. Further study is needed to assess the potential additional value of HAI therapy in converting patients with hepatic metastases to candidates for resection.

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References

  1. Moore MA et al (2010) Overview of players and information in the cancer epidemiology and control world in Asia. Asian Pac J Cancer Prev 11(Suppl 2):1–10

    Google Scholar 

  2. Scripcariu V, Rosca MG (2009) Treatment for synchronous liver metastasis of colorectal cancer. Rev Med Chir Soc Med Nat Iasi 113(2):442–452

    PubMed  CAS  Google Scholar 

  3. Hughes K, Scheele J, Sugarbaker PH (1989) Surgery for colorectal cancer metastatic to the liver: optimizing the results of treatment. Surg Clin North Am 69(2):339–359

    PubMed  CAS  Google Scholar 

  4. Folprecht G et al (2005) Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol 16(8):1311–1319

    Article  PubMed  CAS  Google Scholar 

  5. Ismaili N (2011) Treatment of colorectal liver metastases. World J Surg Oncol 9:154

    Article  PubMed  PubMed Central  Google Scholar 

  6. Falcone A et al (2007) 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 25(13):1670–1676

    Article  PubMed  CAS  Google Scholar 

  7. Folprecht G et al (2010) Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol 11(1):38–47

    Article  PubMed  CAS  Google Scholar 

  8. Breedis C, Young G (1954) The blood supply of neoplasms in the liver. Am J Pathol 30(5):969–977

    PubMed  CAS  PubMed Central  Google Scholar 

  9. Anand A et al (1996) Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst 88(12):838–839

  10. Kemeny NE et al (2006) Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life, and molecular markers (CALGB 9481). J Clin Oncol 24(9):1395–1403

    Article  PubMed  CAS  Google Scholar 

  11. Nitti D et al (1997) Hepatic arterial infusion (HAI) for unresectable liver metastases (ULM) from colorectal carcinoma. Tumori 83(1 Suppl):S61

    PubMed  CAS  Google Scholar 

  12. Kemeny N et al (2001) Phase I study of hepatic arterial infusion of floxuridine and dexamethasone with systemic irinotecan for unresectable hepatic metastases from colorectal cancer. J Clin Oncol 19(10):2687–2695

    PubMed  CAS  Google Scholar 

  13. Saltz LB et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer: Irinotecan study group. N Engl J Med 343(13):905–914

    Article  PubMed  CAS  Google Scholar 

  14. Kemeny NE et al (2009) Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma. J Clin Oncol 27(21):3465–3471

    Article  PubMed  PubMed Central  Google Scholar 

  15. Adam R et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 240(4):644–657; discussion 657-8

    PubMed  PubMed Central  Google Scholar 

  16. Kemeny N et al (2009) Phase I trial of adjuvant hepatic arterial infusion (HAI) with floxuridine (FUDR) and dexamethasone plus systemic oxaliplatin, 5-fluorouracil and leucovorin in patients with resected liver metastases from colorectal cancer. Ann Oncol 20(7):1236–1241

    Article  PubMed  CAS  Google Scholar 

  17. Kemeny N et al (2005) Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol 23(22):4888–4896

    Article  PubMed  CAS  Google Scholar 

  18. Fong Y et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 230(3):309–318; discussion 318-21

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Kaba H et al (2004) Reliability at the national cancer institute-common toxicity criteria version 2.0. Gan To Kagaku Ryoho 31(8):1187–1192

    PubMed  Google Scholar 

  20. Sullivan RD, Norcross JW, Watkins EJ (1964) Chemotherapy of metastatic liver cancer by prolonged hepatic-artery infusion. N Engl J Med 270:321–327

    Article  PubMed  CAS  Google Scholar 

  21. Koea JB, Kemeny N (2000) Hepatic artery infusion chemotherapy for metastatic colorectal carcinoma. Semin Surg Oncol 19(2):125–134

    Article  PubMed  CAS  Google Scholar 

  22. Ensminger WD, Gyves JW (1983) Clinical pharmacology of hepatic arterial chemotherapy. Semin Oncol 10(2):176–182

    PubMed  CAS  Google Scholar 

  23. Ensminger WD (2002) Intrahepatic arterial infusion of chemotherapy: pharmacologic principles. Semin Oncol 29(2):119–125

    Article  PubMed  CAS  Google Scholar 

  24. Kemeny N et al (1984) Hepatic artery pump infusion: toxicity and results in patients with metastatic colorectal carcinoma. J Clin Oncol 2(6):595–600

    PubMed  CAS  Google Scholar 

  25. Balch CM, Urist MM (1986) Intraarterial chemotherapy for colorectal liver metastases and hepatomas using a totally implantable drug infusion pump. Recent Results Cancer Res 100:234–247

    Article  PubMed  CAS  Google Scholar 

  26. Cohen AM et al (1983) Regional hepatic chemotherapy using an implantable drug infusion pump. Am J Surg 145(4):529–533

    Article  PubMed  CAS  Google Scholar 

  27. Niederhuber JE et al (1984) Regional chemotherapy of colorectal cancer metastatic to the liver. Cancer 53(6):1336–1343

    Article  PubMed  CAS  Google Scholar 

  28. Schwartz SI, Jones LS, McCune CS (1985) Assessment of treatment of intrahepatic malignancies using chemotherapy via an implantable pump. Ann Surg 201(5):560–567

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  29. Shepard KV et al (1985) Therapy for metastatic colorectal cancer with hepatic artery infusion chemotherapy using a subcutaneous implanted pump. J Clin Oncol 3(2):161–169

    PubMed  CAS  Google Scholar 

  30. Weiss GR et al (1983) Long-term hepatic arterial infusion of 5-fluorodeoxyuridine for liver metastases using an implantable infusion pump. J Clin Oncol 1(5):337–344

    PubMed  CAS  Google Scholar 

  31. Harmantas A, Rotstein LE, Langer B (1996) Regional versus systemic chemotherapy in the treatment of colorectal carcinoma metastatic to the liver. Is there a survival difference? Meta-analysis of the published literature. Cancer 78(8):1639–1645

    Article  PubMed  CAS  Google Scholar 

  32. Ensminger WD et al (1978) A clinical-pharmacological evaluation of hepatic arterial infusions of 5-fluoro-2′-deoxyuridine and 5-fluorouracil. Cancer Res 38(11 Pt 1):3784–3792

    PubMed  CAS  Google Scholar 

  33. Collins JM (1984) Pharmacologic rationale for regional drug delivery. J Clin Oncol 2(5):498–504

    PubMed  CAS  Google Scholar 

  34. Kemeny N et al (2003) Phase I/II study of hepatic arterial therapy with floxuridine and dexamethasone in combination with intravenous irinotecan as adjuvant treatment after resection of hepatic metastases from colorectal cancer. J Clin Oncol 21(17):3303–3309

    Article  PubMed  CAS  Google Scholar 

  35. Huitzil FD, Capanu M, Paty P (2008) Predictive factors for resection of unresectable metastases from colorectal cancer in patients treated with hepatic arterial infusion (HAI) with fluxuridine (FUDR) and dexamethasone (DEX) plus IV oxaliplatin (Oxali) and irinotecan (CPT). Presented at: the American Society of Clinical Oncology: 2008 gastrointestinal cancers symposium; Jan 25–28 2008; Orlando, FL Abstract 31

  36. Power DG, Healey-Bird BR, Kemeny NE (2008) Regional chemotherapy for liver-limited metastatic colorectal cancer. Clin Colorectal Cancer 7(4):247–259

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This clinical trial is funded by single disease fund of Sun Yat-Sen University Cancer Center.

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Authors and Affiliations

  1. Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Cong Li, Fenghua Wang, Zhiqiang Wang, Huiyan Luo, Ruihua Xu, Youjian He & Yuhong Li

  2. Department of Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Yangkui Gu, Ming Zhao & Wang Li

  3. Department of Hepatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Yunfei Yuan

  4. Department of Medical Oncology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Cui Chen

  5. Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Gong Chen, Peirong Ding, Xiaojun Wu, Zhenhai Lu, Zhizhong Pan & Desen Wan

Authors
  1. Cong Li
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  2. Yangkui Gu
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  3. Ming Zhao
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  7. Wang Li
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  15. Ruihua Xu
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  16. Youjian He
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  17. Desen Wan
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  18. Yuhong Li
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Corresponding author

Correspondence to Yuhong Li.

Additional information

Cong Li and Yangkui Gu are both first authors.

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Li, C., Gu, Y., Zhao, M. et al. Phase I trial of hepatic arterial infusion (HAI) of floxuridine with modified oxaliplatin, 5-fluorouracil and leucovorin (m-FOLFOX6) in Chinese patients with unresectable liver metastases from colorectal cancer. Cancer Chemother Pharmacol 74, 1079–1087 (2014). https://doi.org/10.1007/s00280-014-2585-7

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  • DOI: https://doi.org/10.1007/s00280-014-2585-7

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