Transarterial chemoembolization with raltitrexed-based or floxuridine-based chemotherapy for unresectable colorectal cancer liver metastasis

Abstract

Purpose To evaluate and compare the efficiency and safety of raltitrexed-or floxuridine (FUDR)-based transarterial chemoembolization (TACE) in patients with unresectable colorectal cancer liver metastasis (CRCLM). Methods We conducted a retrospective analysis of 81 patients with unresectable CRCLM who failed systemic chemotherapy and were treated with TACE in our department from Oct 2014 to Oct 2017. Of these, 61 patients received TACE using raltitrexed, oxaliplatin, and pirarubicin (raltitrexed group), and 20 received TACE using FUDR, oxaliplatin, and pirarubicin (FUDR group). The objective response rate (ORR), disease control rate (DCR), overall survival (OS, from the first TACE), progression-free survival (PFS, from the first TACE), and adverse reactions were evaluated and compared between the two groups, and prognostic factors for OS were analyzed. Results The ORRs of the raltitrexed group and FUDR group were 67.2 and 45.0%, respectively (P = 0.076), and the DCRs were 86.9 and 80.0%, respectively (P = 0.452). The median OS (from first TACE) was 14.0 months in the raltitrexed group and 13.0 months in the FUDR group (P = 0.556). The median PFS (from first TACE) was 2.1 months in the raltitrexed group and 2.4 months in the FUDR group (P = 0.878). Univariate and multivariate analyses showed that the primary tumor site, Child-Pugh class, and combination with local ablation (RFA or CRA) were independent significant factors affecting survival. There were no significant differences in adverse reactions between the two groups (P > 0.05), and no treatmentrelated death occurred in either group. Conclusion TACE treatment based on raltitrexed or FUDR is an efficient and safe alternative choice for treating unresectable CRCLM.

<p>Predictive And Prognostic Value Of Hepatic Steatosis In Conversion Therapy For Colorectal Liver-limited Metastases: A Propensity Score Matching Analysis</p>

“…In accordance with previous reports, our results also showed that targeted therapy served as an independent prognostic factor for both PFS and OS, while TACE, as a regular means of local treatment, was an independent prognostic factor for PFS 8,23,35. Our results also showed that patients with unresectable CLLMs would benefit from systemic therapy first mode rather than primary lesion resected mode in the overall survival, which is consistent with previous reports 36.…”

Raltitrexed as a synergistic hyperthermia chemotherapy drug screened in patient-derived colorectal cancer organoids

“…Inhibition of TS can lead to DNA breakage and apoptosis 16 . Raltitrexed is a direct and specific TS inhibitor that can enhance the inhibition ability of TS and prolong the inhibition time 17 .…”

Real-life multidisciplinary treatment for unresectable colorectal cancer liver metastases including hepatic artery infusion with chemo-filtration and liquid biopsy precision oncotherapy: observational cohort study

“…With respect to third-line locoregional therapy for patients with unresectable CRCLM, the present study can be compared to two studies of raltitrexed-based TACE (Guo et al 2017;Wei et al 2019). In the Fudan University Shanghai Cancer Center/Xintai Taishan Medical University study (Wei et al 2019), a median OS of 14 months (PFS of 2.1 months) was reported for raltitrexed (4 mg) combined with oxaliplatin (100 mg) and pirarubicin (60 mg), whereas a median OS of 20.6 (PFS of 4.9 months) was reported in the Peking University Cancer Hospital study (Guo et al 2017) for epirubicin (40 mg plus spongostan particles and iodized oil/lipiodol), followed by 48 h HAI with raltitrexed (3 mg/m 2 ) combined with oxaliplatin (85 mg/m 2 ) and 5-fluorouracil (2000 mg/ m 2 ). The small-sample size (18 patients) in the latter study and failure to report prior first-and second-line systemic chemotherapeutic regimens in both studies, however, limit further discussion of the impressive 20.6-month OS in Peking University Cancer Hospital study (Guo et al 2017).…”

“…Loco-regional chemoembolization (TACE) (Fiorentini et al 2017b(Fiorentini et al ,2018Guo et al 2017;Wei et al 2019) and hepatic artery infusion (HAI) are considered for the third-line therapy in unresectable CRCLM, with the latter indicated for elderly patients with poor performance status and those who refuse surgery or systemic chemotherapy or progress following systemic chemotherapy or to prolong intervals between cycles of systemic chemotherapy (Fiorentini et al 2017a). Risks associated with HAI include treatable catheter and/or port/pump placement complications, life-threatening biliary sclerosis, hepatotoxicity, and/or systemic toxicity (Kingham et al 2010), which can be reduced by chemo-filtration (Fiorentini et al 2004a).…”