Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case–Control Study

Dhir, Mashaal; Jones, Heather L.; Shuai, Yongli; Clifford, Amber K.; Perkins, Samantha; Steve, Jennifer; Hogg, Melissa E.; Choudry, M. Haroon A.; Pingpank, James F.; Holtzman, Matthew P.; Zeh, Herbert J.; Bahary, Nathan; Bartlett, David L.; Zureikat, Amer H.

doi:10.1245/s10434-016-5418-6

Cited by 42 publications

(28 citation statements)

References 33 publications

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“…More than half of patients diagnosed with colorectal cancer present with or eventually develop liver metastases, only 10%-20% of which are resectable at presentation. A percentage of these metastases may be downstaged for surgery by treatment with chemotherapy and targeted agents (2,3). However, patients with liver metastases which remain unresectable have a poor prognosis and are generally given second-line chemotherapy, with a median survival of approximately one year (3).…”

Section: Introductionmentioning

confidence: 99%

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Kennedy

Cohn

Coldwell

et al. 2017

J. Gastrointest. Oncol.

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Background: The Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) study was a retrospective analysis of 606 patients with unresectable colorectal liver metastases treated with radioembolization (RE) using 90 Y-labeled resin microspheres. The first analysis of this study was completed with a last patient follow-up of 77.7 months. We now provide an updated survival analysis through September 15, 2016, with a last patient follow-up of 125 months. Methods: 90 Y-RE was considered for patients with advanced liver-only or liver-dominant metastatic colorectal cancer which was deemed not suitable for surgery, ablation, or systemic therapy, and which had progressed or become refractory to at least one line of systemic therapy. All patients with a diagnosis of metastatic colorectal cancer who had received at least 1 RE treatment and 1 follow-up visit were included in the analysis. Patients were treated between July 2002 and December 2011 at one of 11 U.S. tertiary care centers. Data were collected at baseline, on the day of the first 90 Y-RE treatment (day 0), and at all subsequent visits or until death. Patient medical charts and/or public records were accessed to obtain dates of death. Results: Dates of death were obtained for 574 out of a total of 606 patients, and overall survival (OS) data analyzed. Updated median OS was 10.0 months (95% CI: 9.2-11.8 months) at a median follow-up of 9.5 months versus the originally reported median OS of 9.6 months (95% CI: 9.0-11.1 months) at a follow-up of 8.6 months in the first MORE analysis. Patients received a median (range) of 2 (0 to 6) lines of chemotherapy. Baseline characteristics and factors significantly associated with patient survival (P<0.01) are consistent with those reported in the first safety analysis of the MORE study. These factors include poor ECOG performance status, markers of advanced disease such as increased extent of tumor-to-target liver involvement, poor baseline liver function, pre-treatment anemia, lung shunt fraction, and number of lines of prior chemotherapy. Patient age did not significantly affect survival outcomes. Conclusions: Long-term follow-up confirms that 90 Y-RE treatment offers favorable survival benefits for patients with unresectable metastatic colorectal cancer, even among patients who received 3 or more prior lines of chemotherapy. Our analysis also supports earlier reported prognostic factors for survival after 90 Y-RE. Overall, our updated analysis confirms that 90 Y-RE treatment provided a meaningful response and survival advantage for MORE patients across all ages and across diverse community and academic centers in the U.S.

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Section: Introductionmentioning

confidence: 99%

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Kennedy

Cohn

Coldwell

et al. 2017

J. Gastrointest. Oncol.

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“…Currently, HAIP use is indicated for patients with unresectable CRLM or as adjuvant therapy after operation among patients at high risk of hepatic recurrence . When used in combination with modern systemic chemotherapy for unresectable CRLM, HAIP therapy is associated with response rates of 55% to 88%, median overall survival of nearly 3 years, and half of the patients convert to resectable . In addition, conversion to potentially resectable disease occurs in nearly half of the patients …”

Section: Introductionmentioning

confidence: 99%

“…Despite encouraging results, utilization of HAIP for CRLM remains limited to a few centers . Establishing a HAIP program is labor intensive and requires the expertize of medical oncologists, chemotherapy pharmacists, nurses, surgeons, and others.…”

Section: Introductionmentioning

confidence: 99%

Implementation and early outcomes for a surgeon‐directed hepatic arterial infusion pump program for colorectal liver metastases

Chakedis

Beal

Sun

et al. 2018

Journal of Surgical Oncology

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Introduction Hepatic arterial infusion pump (HAIP) therapy for colorectal liver metastases (CRLM) is beneficial in selected patients yet wide acceptance in the oncology community is lacking. Methods A surgeon‐led team implemented a HAIP program in 2012. Pumps were placed by laparotomy for CRLM and fluorodeoxyuridine was infused via HAIP every 28 days without systemic chemotherapy supervised by the operating surgeon. Results Sixty patients were treated with HAIP, either in the adjuvant setting after liver resection or ablation of CRLM in 26 (43%) patients or with the unresectable disease in 34 (57%). Perioperative complications occurred in 19 (32%) and pump‐specific complications in 14 (23%) that included intrahepatic biliary stricture in one (2%). Time to liver progression was a median 9.2 months (95% CI, 3.1‐15.3 months) in unresectable patients and liver recurrence was a median 24.7 months (2.5‐46.9 months) in the adjuvant group. Estimated 3‐year overall survival from the time of HAIP placement was 64% in the adjuvant group and 37% in the unresectable group. Sarcopenia was prevalent (48%) and was associated with a worse survival (HR 2.4, 95% CI, 1.1‐5.0). Conclusion A surgeon‐led HAIP program may achieve outcomes on par with those of experienced centers and foster strong relationships between surgical and medical oncologists.

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“…Pak et al report the findings from a prospective phase II trial evaluating combination HAI and systemic chemotherapy, wherein 47 of the 64 enrolled patients with unresectable hepatic metastases (73%) responded to treatment, and 33 were converted to resectable disease (52%). Similarly, a case‐control study from Pittsburgh found that patients who underwent treatment with HAI plus systemic chemotherapy had a median overall survival of 32.8 months compared with 15.3 months in the chemotherapy alone group ( P < 0.001) …”

Section: Liver‐directed Therapiesmentioning

confidence: 82%

Nonresectional regional therapies for metastatic colorectal cancer to the liver

Schlick

Merkow

Bentrem

2019

Journal of Surgical Oncology

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The liver is the second leading site of colorectal cancer metastases, following the lymph nodes. Although metastatic resection for colorectal cancer liver metastases has been shown to improve survival, many patients cannot undergo surgery. Several nonsurgical therapies are available in these situations, however high‐quality evidence comparing the effectiveness of these therapies is sparse. Here, we review the currently available evidence in support of nonresectional regional therapies for colorectal metastases to the liver.

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Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case–Control Study

Abstract: In this case-control study of patients with IU-CRCLM, HAI in combination with CT was associated with improved OS when compared with modern systemic CT alone.

Cited by 42 publications

References 33 publications

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Implementation and early outcomes for a surgeon‐directed hepatic arterial infusion pump program for colorectal liver metastases

Nonresectional regional therapies for metastatic colorectal cancer to the liver

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