Multimodal therapy with intravenous biweekly leucovorin, 5-fluorouracil and irinotecan combined with hepatic arterial infusion pirarubicin in non-resectable hepatic metastases from colorectal cancer (a European Association for Research in Oncology trial)

Zelek, Laurent; Bugat, R.; Cherqui, Daniel; Ganem, G.; Valleur, Patrice; Guimbaud, Rosine; Dupuis, Olivier; Aziza, T.; Fagniez, Pierre-Louis; Auroux, Jean; Kobeiter, Hicham; Tayar, Claude; Braud, Anne-Chantal; Haddad, Elias; Piolot, A.; Buyse, Marc; Piedbois, Pascal

doi:10.1093/annonc/mdg404

Cited by 68 publications

(24 citation statements)

References 18 publications

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“…HAI plus systemic chemotherapy has been associated with response rates of 60-90% for unresectable CLM, even in the second and third line settings, with conversion to resectability in up to 35% of patients [3,4,[15][16][17][18]. Critics of this approach cite a significant incidence of short-and long-term complications, including complications related to the pump itself and biliary sclerosis, which is reversible if recognized in its early stages but can lead to stricture and liver failure.…”

Section: Discussionmentioning

confidence: 99%

Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases

White

Schwartz

Muñoz

et al. 2008

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases

White

Schwartz

Muñoz

et al. 2008

Journal of Surgical Oncology

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“…In 2003, a French group published a phase ii study using an anthracycline, pirarubicin, delivered through a femorally placed hepatic artery catheter, plus systemic irinotecan, 5fu, and leucovorin given every 2 weeks 13 . Although the tumour response rate was 48%, 75% of patients experienced grades 3 and 4 neutropenia.…”

Section: Hai Pump Plus Systemic Chemotherapymentioning

confidence: 99%

Hepatic arterial infusion pump chemotherapy for colorectal liver metastases: an old technology in a new era

Ko¹,

Karanicolas²

2013

Curr. Oncol.

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“…In unselected populations with advanced colorectal cancer, oxaliplatinbased therapy produces secondary resection rates of 15%-22% and complete resection rates (R0) of 9%-13% (Table 1) [14, [23][24][25] . Among patients treated with irinotecanbased regimens, approximately 9% become eligible for surgery and 7% will achieve complete resection (Table 2) [14,23, [26][27][28] . Comparative data from several studies suggest that oxaliplatin-based regimens may be more effective than irinotecan-based regimens in converting unresectable disease to resectable disease [14,29,30] , although this finding has not always been consistent [23] .…”

Section: Secondary Resection Following Standard Chemotherapymentioning

confidence: 99%

“…The median survival was 26 mo. Additional studies have evaluated irinotecanbased regimens in selected patient populations; resection rates were generally 30%-40% [26][27][28] . …”

mentioning

confidence: 99%

Secondary hepatic resection as a therapeutic goal in advanced colorectal cancer

Saif¹

2009

WJG

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Surgery is the only curative option for patients with liver metastases of colorectal cancer, but few patients present with resectable hepatic lesions. Chemotherapy is increasingly used to downstage initially unresectable disease and allow for potentially curative surgery. Standard chemotherapy regimens convert 10%-20% of cases to resectable disease in unselected populations and 30%-40% of those with disease confined to the liver. One strategy to further increase the number of candidates eligible for surgery is the addition of active targeted agents such as cetuximab and bevacizumab to standard chemotherapy. Data from a phase Ⅲ trial indicate that cetuximab increases the number of patients eligible for secondary hepatic resection, as well as the rate of complete resection when combined with first-line treatment with the FOLFIRI regimen. The safety profiles of preoperative cetuximab or bevacizumab have not been thoroughly assessed, but preliminary evidence indicates that these agents do not increase surgical mortality or exacerbate chemotherapyrelated hepatotoxicity, such as steatosis (5-fluorouracil), steatohepatitis (irinotecan), and sinusoidal obstruction (oxaliplatin). Secondary resection is a valid treatment goal for certain patients with initially unresectable liver metastases and an important end point for future clinical trials. INTRODUCTIONGlobally, one half of the nearly 1 million patients diagnosed with colorectal cancer annually will develop liver metastases during the course of the disease [1,2] . Autopsy findings suggest that approximately 50% of patients who die of colorectal cancer have liver metastases, which are the only site of metastatic disease in approximately 20%-30% of patients [3] and the cause of death in most of these patients [4] . In other types of cancer, liver metastases are a sign of distant dissemination, and surgery is not a curative option [5] . In colorectal cancer, however, portal vein drainage from the gastrointestinal tract to the liver favors metastasis to the liver without systemic dissemination [5] . Surgery therefore provides a potentially curative treatment option for patients with resectable liver disease [6] , in contrast with palliative chemotherapy for those with unresectable disease.One of the most important recent advances in the management of advanced colorectal cancer is the concept of downstaging initially unresectable disease using chemotherapy so that more patients become eligible for potentially curative surgery. Current treatment guidelines [4] and substantial research highlight the importance of increasing the rates of secondary resection in initially unresectable disease. The addition of active targeted therapies, such as cetuximab and bevacizumab, to chemotherapy may further increase secondary resection rates. This article summarizes the current data on secondary resection of initially unresectable liver metastases of colorectal cancer using currently available systemic therapy regimens. HOW RESECTABILITY MAY BE ACHIEVEDReported 5-year survival r...

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Multimodal therapy with intravenous biweekly leucovorin, 5-fluorouracil and irinotecan combined with hepatic arterial infusion pirarubicin in non-resectable hepatic metastases from colorectal cancer (a European Association for Research in Oncology trial)

Abstract: The multimodality approach used in the present study was well-tolerated and yielded dramatic responses. An aggressive approach combining i.v. and HAI chemotherapy deserves further investigation.

Cited by 68 publications

References 18 publications

Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases

Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases

Hepatic arterial infusion pump chemotherapy for colorectal liver metastases: an old technology in a new era

Secondary hepatic resection as a therapeutic goal in advanced colorectal cancer

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