Safety and Efficacy of Combined Yttrium 90 Resin Radioembolization with Aflibercept and FOLFIRI in a Patient with Metastatic Colorectal Cancer

Abstract

Background. When associated with isolated four or fewer liver foci, metastatic colorectal cancer is amenable to surgical resection. Alternative therapeutic methods for isolated liver metastases include radioembolization with yttrium 90 (Y90) and transarterial chemoembolization (TACE). We present here a case of a patient with two sites of liver metastatic disease from colorectal cancer who underwent Y90 radioembolization combined with aflibercept and FOLFIRI. Case Report. A 56-year-old female with history of bilateral breast cancer and metastatic colon cancer with prior hemicolectomy and 4 previous chemotherapy regimens developed liver metastasis. She was started on aflibercept and FOLFIRI and concurrently underwent two treatments of radioembolization with Y90, initially targeting the largest right lobe tumor, and then a subsequent treatment targeting the smaller left lobe tumor with retreatment of the right lobe tumor. Her liver metastases exhibited partial response on imaging utilizing the modified RECIST criteria. Interestingly, the patient CEA levels decreased after the procedure. Discussion. This is the first reported case of a patient managed with radioembolization with Y90 combined with aflibercept, an anti-VEGF treatment, and FOLFIRI. An ongoing randomized clinical trial aims to define the role of combined targeted therapy and chemotherapy with radioembolization with Y90.

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

“…There is also a published case study on the use of 90 Y-RE in combination with FOLFIRI chemotherapy and the anti-angiogenic agent aflibercept in treatment of metastatic colorectal cancer liver metastases. The authors of this case study report that the patient's liver metastases showed partial response, and conclude that this combination therapy was both safe and efficacious in this patient (24).…”

Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry

“…A case study was reported using radioembolization in combination with aflibercept (vascular endothelial growth factor inhibitor), with a folinic acid, flurouracil, irinotecan (FOLFIRI) regimen for the treatment of a metastatic CRC. 104 Another example is a recent multicentre Phase II trial examining the safety and efficacy of radioembolization followed by the multikinase inhibitor sorafenib. 71…”

Radioembolization of Hepatic Malignancies: Evolving Practice Guidelines, Techniques, and Applications

“…To our knowledge this methodology has not been applied dually against isolated HCC. Weakly homologous attempts have been made against biliary tract cancer [9] and metastatic colorectal cancer [10] which shows promise but a need for further work. A practical approach may be to suspend cancerous cells in a broth of TACE agents and to observe their course with and without additive impregnation of radiospheres.…”