The use of trans-arterial chemo-embolization with irinotecan drug eluted beads (DEBIRI) for liver-dominant metastatic colorectal cancer (mCRC) is usually proposed for end-stage patients as a salvage treatment without any concomitant systemic treatment. The goals of our study were to evaluate the safety and efficacy of the DEBIRI procedure, in patients treated by concomitant systemic chemotherapy.
Between 04/2011 and 04/2014, all consecutive ECOGPS 0-2 patients with stable or progressive liver-dominant mCRC pretreated by at least 2 previous chemotherapy lines, were referred for DEBIRI as salvage treatment. All patients received in addition systemic chemotherapy. Safety of the procedure, toxicities (NCI-CTC AE V4.02), tumor response rates (RECIST 1.1), progression-free (PFS) and overall survivals (OS), were recorded.
Forty-nine consecutive patients (mean age: 63 years) underwent 81 DEBIRI sessions administered in a lobar manner in the same session. All patients had previously received chemotherapy by FOLFOX and FOLFIRI and 49% with biotherapies. RAS status was mutated in 45% of cases. Patients received concomitant systemic chemotherapy (capecitabine: 26%, FOLFOX +/- bevacizumab: 51%, other 23%). 35% didn't received the second DEBIRI due to a rapid disease progression (20%) or limiting toxicity (15%). Altogether, 45 (55%) grade 3/4 arterial hypertension crises occurred during the procedure, 11 (14%) grade 3 post-embolization syndrome and 5 (6%) grade 2-3 toxicities (cholecystitis, pancreatitis or non-malignant ascites) were observed. All toxicities were successfully managed. No toxic death occurred. The mean hospital stay was 4.5 days. The 3-month response and disease control rates were 15% and 75%, respectively. Tumor response was correlated with tumor involvement. Median PFS and OS were 8.1 and 21 months, respectively.
DEBIRI plus systemic chemotherapy for pretreated liver-dominant mCRC provide promising efficacy results together with specific and severe side effects that need to be adequately managed.
Clinical trial identification
Legal entity responsible for the study
European Hospital George Pompidou
All authors have declared no conflicts of interest.