Response rates of hepatic arterial infusion pump therapy in patients with metastatic colorectal cancer liver metastases refractory to all standard chemotherapies

Abstract

Background and Objectives To evaluate the role of hepatic arterial infusion (HAI) in patients with metastatic colorectal cancer (mCRC) liver metastases (LM) refractory to oxaliplatin, irinotecan, and fluorouracil-based treatments. Methods A search identified patients with mCRC treated after tumor progression on at least three standard systemic therapies. Results One hundred and ten patients met criteria for inclusion (i.e., progression on at least three standard agents). Fifty seven patients had LM-only and 53 patients had LM and low volume extrahepatic metastases (LME). Patients with LM-only and LME had a response rate (RR) of 33% and 36%, median survival of 20 months and 11.4 months, respectively. Patients with LM-only had progression free survival of 6 months and hepatic progression free survival of 7.56 months. In a secondary analysis, 46 patients were RECIST-refractory to all standard therapies: LM-only (n = 24) and LME (n = 22). LM-only and LME had a RR of 29% and 36%, and median survival 17.2 months and 9.1 months, respectively. Conclusions Patients with refractory mCRC LM can achieve a response to HAI resulting in antitumor activity and improvement in survival. Responses are rarely seen in such heavily treated patients with systemic therapy alone, suggesting a regional directed approach is useful.

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

“…Despite this, outcomes for most were encouraging with response or stable disease in 78% of those with unresectable disease. Response rates of 33% from HAIP therapy can be expected overall, even in patient’s refractory to multiple lines of systemic chemotherapy with overall survival of 20 months …”

Treatment sequencing for simultaneous colorectal liver metastases

“…Though outside the scope of this review, regional therapies like hepatic artery infusion chemotherapy have gained increased attention, particularly in the context of conversion therapy. Reported liver metastases’ response rates are higher than 90% in studies examining hepatic artery infusion chemotherapy in the first‐line setting and more than 50% in the second or third line . Combined hepatic artery infusion and systemic chemotherapy is associated with conversion rates as high as 50% …”

“…Reported liver metastases' response rates are higher than 90% in studies examining hepatic artery infusion chemotherapy in the first-line setting and more than 50% in the second or third line. 45,46 Combined hepatic artery infusion and systemic chemotherapy is associated with conversion rates as high as 50%. 47 Taken together, these series suggest that in patients with resectable metastases selected for surgery, including those with simultaneous metastases, chemotherapy response is not generally associated with prognosis.…”

Oligometastases of Gastrointestinal Cancer Origin

“…For patients with unresectable metastases to the liver, HAI can be used with systemic chemotherapy to achieve increased response rates even in patients after progression on first-and second-line chemotherapy [27]. Results show increased response and conversion to resection with the use of HAI and systemic therapy versus systemic therapy alone.…”