Evaluation of biliary toxicity in patients with hepatic artery infusion pumps

Abstract

Purpose Identify risk factors for biliary toxicity in patients with colorectal liver metastases who received floxuridine (FUDR) via a surgically implanted hepatic artery infusion pump (HAIP). Describe the incidence of biliary toxicity and evaluate relevant patterns in the biliary toxicity cohort. Methods A single center, retrospective, case-control study included adult colorectal cancer patients with liver metastases who received at least one cycle of FUDR via a surgically implanted HAIP from 1 January 2017, to 1 October 2021. Patients were excluded if they had incomplete records, cholangiocarcinoma diagnosis, or received concurrent mitomycin and FUDR. Biliary toxicity criteria derived from existing HAIP literature were utilized to determine whether patients experienced biliary toxicity. Multiple variables were compared by univariate statistical analysis between the biliary toxicity and non-biliary toxicity cohorts to identify potential risk factors for development of FUDR-induced biliary toxicity. Results Out of 50 patients who had a HAIP implanted, 39 met the inclusion criteria. Five of the 39 patients (12.7%) included in the analysis met the pre-specified biliary toxicity criteria. No risk factors for biliary toxicity were identified. All five patients who developed biliary toxicity demonstrated elevations in alkaline phosphatase (ALP) prior to meeting the toxicity criteria. Conclusion Biliary toxicity remains a significant and therapy-limiting consequence of FUDR administration. Rising ALP may be an early indicator of subsequent biliary toxicity. Future studies with more patients may identify risk factors that can facilitate risk mitigation strategies.

Contemporary Surgical Management of Colorectal Liver Metastases

“…The authors noted that the risk factors for BS were postoperative infectious complications (50.0% vs. 14.8%, p = 0.002) and larger dose/cycle/weight of FUDR (2.6 vs. 2.0 mg/cycle/kg, p = 0.025); they also noted that the development of BS did not negatively impact survival in these patients (BS vs. non-BS: 61.0 months vs. 47.2 months, p = 0.316). Additionally, prior studies have demonstrated that biliary toxicity from HAIP can be limited by the concomitant administration of dexamethasone with FUDR [ 131 ] and that an increase in alkaline phosphatase (ALP) may be an early indicator of toxicity [ 132 ]. As such, frequent lab monitoring can be used for surveillance purposes, and dose adjustments or treatment breaks have been shown to limit BS development [ 133 ].…”