Hepatic Arterial Infusion Chemotherapy OS Benefit Reported For CRC Liver Metastases

Adding a hepatic arterial infusion to systemic chemotherapy may boost overall survival after complete resection of colorectal cancer liver metastases

medwireNews: Use of perioperative hepatic arterial infusion chemotherapy (HAI) in patients undergoing complete resection of colorectal cancer (CRC) liver metastases may extend overall survival (OS) by approximately 2 years, research suggests.

Median OS was 67 months for the 785 patients who were scheduled to receive six cycles of intra-arterial floxuridine alongside preoperative and/or adjuvant systemic chemotherapy, including irinotecan or oxaliplatin for most (96.1%) patients who received treatment after 1998.

This was significantly longer than the 44 months achieved by the 1583 patients given systemic treatment only, say Bas Groot Koerkamp, from Erasmus MC Cancer Institute in Rotterdam, the Netherlands, and co-investigators.

Rates of 5-year and 10-year OS were both significantly higher in the HAI group than controls, at 52.9% versus 37.9% and 38.0% versus 23.8%, respectively.

The authors emphasize in the Journal of Clinical Oncology that OS was improved despite patients in the HAI group having more advanced disease than controls, as demonstrated by a higher number of tumours (mean 3.5 vs 2.4) and higher rates of N2 disease (26.9 vs 21.9%) and synchronous liver metastases (59.6 vs 45.0%).

And the difference in OS between the HAI and control groups remained after excluding patients who had extrahepatic disease (EHD) completely resected before or at the same time as their colorectal cancer liver metastases (median 68 vs 46 months) and after excluding patients who did not receive modern systemic chemotherapy (median 67 vs 47 months).

After adjustment by propensity score for seven prognostic markers, the hazard ratio for OS was 0.67 in favour of perioperative HAI, the team says.

Subgroup analysis confirmed the OS benefit of HAI except in patients with EHD, a positive resection margin or a clinical risk score of 4–5, while the greatest treatment differences in OS were found in patients with a node-negative primary tumour or a low clinical risk score.

The researchers therefore suggest that a randomised controlled trial should be conducted in patients with node-negative colorectal cancer and those with a low clinical risk score as these patients are most likely to benefit from and confirm HAI efficacy.

“Future research should also evaluate genomic data (eg, KRAS status) to improve patient selection”, they add.

Reference

Koerkamp BG, Sadot E, Kemeny NE, et al. Perioperative hepatic arterial infusion pump chemotherapy is associated with longer survival after resection of colorectal liver metastases: A propensity score analysis. J Clin Oncol; Advance online publication 20 April 2017. DOI: 10.1200/JCO.2016.71.8346

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