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Hepatic Arterial Infusion of Oxaliplatin and Intravenous LV5FU2 in Unresectable Liver Metastases from Colorectal Cancer after Systemic Chemotherapy Failure

  • Gastrointestinal Oncology
  • Original Papers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We have previously shown promising activity of hepatic arterial infusion (HAI) oxaliplatin combined with intravenous (IV) 5-fluorouracil (5-FU) and leucovorin (LV) as first-line chemotherapy in patients with colorectal liver metastases (CRLM) (intent-to-treat [ITT] objective response rate [ORR], 64%; secondary resection rate, 18%; overall survival [OS], 27 months). Whether this regimen could be beneficial after systemic chemotherapy failure is unknown.

Methods

Patients with unresectable CRLM and history of systemic chemotherapy failure were treated bimonthly with HAI oxaliplatin (100 mg/m2 2 hours) combined with IV LV and IV bolus and infusional 5FU (modified LV5FU2 regimen).

Results

Forty-four consecutive patients (median age 56 years; median number of prior systemic chemotherapy regimens, 2 range 1–5) were included, of whom 43 (98%) had previously received oxaliplatin (n = 34), irinotecan (n = 37), or both (n = 28). Patients received a median of nine cycles of HAI oxaliplatin and IV modified LV5FU2 (range 0–25). Toxicity included grade 3–4 neutropenia (43%), grade 2–3 neuropathy (43%), and grade 3–4 abdominal pain (14%). We observed 24 partial ORs (62%) among the 39 assessable patients (ITT ORR, 55%; 95% CI, 40–69%), including 17, 12, and 12 patients who had failed to respond to prior systemic chemotherapy with FOLFIRI, FOLFOX, or both, respectively. Tumor response allowed further R0 surgical resection (n = 7) or radiofrequency ablation (n = 1) of initially unresectable CRLM in eight patients (18%). Median progression-free survival and OS were 7 and 16 months, respectively.

Conclusions

HAI oxaliplatin and IV LV5FU2 is feasible, safe, and shows promising activity after systemic chemotherapy failure, allowing surgical resection of initially unresectable CRLM in 18% of patients.

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Acknowledgment

Drs. Valérie Boige, David Malka, and Michel Ducreux declare having received consultancies, honoraria, and grants/funding (for other studies) from Sanofi-Aventis. Dr. Dominique Elias declares having received grants/funding (for other studies) from Sanofi-Aventis.

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Authors and Affiliations

  1. Department of Medicine, Institut Gustave Roussy, Villejuif, France

    Valérie Boige MD, David Malka MD, PhD & Michel Ducreux MD, PhD

  2. Department of Surgery, Institut Gustave Roussy, Villejuif, France

    Dominique Elias MD, PhD, Diane Goere MD & Marc Pocard MD, PhD

  3. Department of Biostatistics, Institut Gustave Roussy, Villejuif, France

    Marine Castaing MS

  4. Department of Radiology, Institut Gustave Roussy, Villejuif, France

    Thierry De Baere MD & Clarisse Dromain MD

Authors
  1. Valérie Boige MD
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  2. David Malka MD, PhD
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  3. Dominique Elias MD, PhD
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  4. Marine Castaing MS
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  5. Thierry De Baere MD
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  6. Diane Goere MD
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  9. Michel Ducreux MD, PhD
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Correspondence to David Malka MD, PhD.

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Boige, V., Malka, D., Elias, D. et al. Hepatic Arterial Infusion of Oxaliplatin and Intravenous LV5FU2 in Unresectable Liver Metastases from Colorectal Cancer after Systemic Chemotherapy Failure. Ann Surg Oncol 15, 219–226 (2008). https://doi.org/10.1245/s10434-007-9581-7

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  • DOI: https://doi.org/10.1245/s10434-007-9581-7

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