Phase III Trial Comparing Protracted Intravenous Fluorouracil Infusion Alone or With Yttrium-90 Resin Microspheres Radioembolization for Liver-Limited Metastatic Colorectal Cancer Refractory to Standard Chemotherapy

Hendlisz, Alain; Eynde, Marc Van den; Peeters, Marc; Maleux, Geert; Lambert, Bieke; Vannoote, Jaarke; Keukeleire, Katrien De; Verslype, Chris; Defreyne, Luc; Cutsem, Éric Van; Delatte, Philippe; Delaunoit, Thierry; Personeni, Nicola; Paesmans, Marianne; Laethem, Jean Luc Van; Flamen, Patrick

doi:10.1200/jco.2010.28.5643

Cited by 362 publications

(241 citation statements)

References 37 publications

(12 reference statements)

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“…Bei mehrfach vorbehandelten, "chemo-refraktären" Patienten (n = 44) induzierte die Hinzunahme der SIRT zu einer 5-FU-Monotherapie im Vergleich zur alleinigen Behandlung mit 5-FU eine Verbesserung von Ansprechrate (10 vs. 0 %) und TTP (4,5 vs. 2,1 Monate, P< 0,03) [1203].…”

Section: Hintergrundunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

136

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Section: Hintergrundunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

136

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“…The most significant study in this setting is the recent report by Hendlisz et al [32]. This was a Phase III study of 46 patients with chemorefractory liver-only colorectal metastases who were randomised to receive either infusional 5FU or infusional 5FU with the additional of RE.…”

Section: Clinical Rationale For Combining Re With Chemotherapy For Sementioning

confidence: 99%

“…It should be noted that, since the biological mechanism of radiosensitisation (as discussed above) may be independent of the mechanism of anti-cancer efficacy of the same drugs used without concomitant radiotherapy, there is a scientific rationale for using a radiosensitising chemotherapy drug that the patient has previously received and may even have previously shown "tumor resistance" to. Oxaliplatin, 5-FU and irinotecan are all radiosensitisers, and the selection of radiosensitising chemotherapy in clinical practice should be guided by the dosing regimes shown to be safe with RE [26,27,32] rather than by the need to control microscopic or macroscopic disease outside the liver. Following the administration of radiosensitising chemotherapy with RE, the patient can subsequently receive a systemic regime which may offer further survival benefit.…”

Section: Guidelines For Combining Re With Systemic Chemotherapymentioning

confidence: 99%

“…In patients who have experienced unacceptable toxicity with oxaliplatin (e.g. persistent peripheral neuropathy), RE can be combined with infusional 5FU [32] or with irinotecan [27], using the dosing regimes of chemotherapy shown to be safe. Our current practice is to administer RE on day 2, 3 or 4 of cycle 1 and to administer 6 weeks of chemotherapy in total for radiosensitisation.…”

Section: Guidelines For Combining Re With Systemic Chemotherapymentioning

confidence: 99%

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Multi-modality Therapy of Hepatic Metastases from Colorectal Carcinoma: Optimal Combination of Systemic Chemotherapy with Radio-embolization

Hill¹,

Sharma²

2011

J Nucl Med Radiat Ther

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Despite major advances in the systemic treatment of metastatic colorectal carcinoma, the 5 year survival rate remains disappointingly low at approximately 7% [1]. Median survival for this patient group is currently in the range 1.5 to 2.5 years, and depends on continuation of systemic therapy for much of the patient's remaining life. Of all patients with metastatic colorectal cancer, 20-30% have liver-only metastases and approximately 50% of recurrences following resection of the primary tumour are confined to the liver alone. Surgical resection of hepatic metastases is the treatment of choice, where possible, but this is feasible for less than 15% of patients at presentation [2]. For the subset of patients with metastatic colorectal cancer in whom surgical resection can be achieved, the 5 year overall survival probability is 30-40%, with 20% of patients achieving long-term cure [3]. Patients with unresectable liver predominant metastases have increasingly become a focus of interest for improving survival for patients with metastatic colorectal cancer. This prioritization is due to the outcomes from Phase II studies utilising downstaging neo-adjuvant chemotherapy in which 10-20% of patients with inoperable liver disease have been converted to curative resection and due to the finding that there is a statistical correlation between tumour response and resection rates across clinical studies [4]. Multimodality treatment combinations of systemic agents with liver surgery have been proffered as a means of improving tumour response rates and so improving the proportion of long term survivors of patients with metastatic colorectal cancer.There has been much optimism that newly developed, expensive, biologically targeted agents may improve survival in this patient group, when combined with systemic chemotherapy, but complete radiological responses or cures remain exceedingly rare. Preliminary data from Phase III trials of chemotherapy and biologically targeted agents have not consistently shown statistically significant increases in response rates,nor the frequency of down-staging to resectability, over chemotherapy alone. There are two limitations of delivering neoadjuvant chemotherapy prior to liver metastectomy. Firstly, the development of pathological liver steatosis and fibrosis, which can occur with oxaliplatin-based chemotherapy or with irinotecan-based chemotherapy, and worsens with cumulative dosing. Secondly, the risk of disease relapse in the liver post-surgery, usually not at the resection site. Of those patients with liver-dominant or liver-only metastases, where the hepatic disease is unlikely to become resectable even with neoadjuvant systemic therapy, there is still a robust rationale for maximising local control of the liver disease, since up to 90% of patients with metastatic colorectal cancer ultimately die of liver failure [5]. Multiple loco-regional strategies are therefore under investigation to improve the outcome for patients with unresectable colorectal liver metastases, including radio-frequen...

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“…It is also considered a tool for bridging to resection, radiofrequency ablation, and liver transplantation [1]. Several reports have shown that TARE could be beneficial in the management of advanced liver malignancy [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%