Aggressive Therapy Feasible for Patients with Spread of Colorectal Cancer

Aggressive Therapy Feasible for Patients with Spread of Colorectal Cancer to Liver.

According to a recently published article in the Annals of Oncology, treatment including intravenous chemotherapy plus hepatic artery infusion (HAI) yields a high anti-cancer response rate and is generally well tolerated in patients with colorectal cancer that has spread to the liver.

The colon and rectum are both parts of the large intestine. Colorectal cancer is a common malignancy in the United States and when caught prior to spread from its site of origin, has a high cure rate. However, once colorectal cancer has spread to distant sites in the body (metastasized), cure rates fall dramatically and long-term survival is rare. A common site in the body for advanced colorectal cancer to spread is the liver, referred to as liver metastasis. Various treatment strategies exist for liver metastasis, including but not limited to systemic (full-body) chemotherapy, HAI, radiofrequency ablation, cryotherapy and/or surgery. Unfortunately, the size and location of liver metastases often prohibits safe surgical removal of the cancer. Researchers are evaluating ways in which to improve survival and quality of life in these patients, as well as effective treatment measures to shrink the cancer enough to permit safe surgical removal.

Researchers from Europe recently conducted a clinical trial to evaluate a combined treatment approach for patients with liver metastases from colorectal cancer. This trial included 31 patients who were treated with systemic chemotherapy consisting of the agents 5-fluorouracil, leucovorin and Camptosar® followed by HAI consisting of pirarubicin. HAI involves direct delivery of chemotherapy to the main artery of the liver through a small catheter that is surgically placed through the skin in the majority of cases. In theory, HAI provides a greater concentration of the chemotherapy agent to the liver as well as spares healthy tissues in the body from the side effects caused by the agent. All of these patients had liver metastases that were considered inoperable at the time of initiation of the trial. Following treatment, nearly half of the patients achieved an anti-cancer response and 35% were able to have their liver metastases surgically removed. Overall, the average duration of survival was 20.5 months, and the average progression-free survival was 9.1 months. In the group of patients that had a complete surgical removal of their cancer, the average progression-free survival was 20.2 months and the average duration of survival had not yet been reached at the time of publication of this trial. There were no treatment-related deaths, and the most common side effect was low white blood cell levels (neutropenia).

The researchers concluded that the combination of systemic chemotherapy consisting of Camptosar®/5-FU/leucovorin plus HAI with pirarubicin provides anti-cancer activity in a large number of patients with colorectal cancer and inoperable liver metastasis. Furthermore, this treatment combination allowed 35% of these patients to undergo the surgical removal of cancer and was generally well tolerated. Patients with advanced colorectal cancer that has metastasized to the liver and cannot be surgically removed may wish to speak with their physician about the risks and benefits of multimodality treatment or the participation in a clinical trial evaluating other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches on behalf of patients are also performed by cancerconsultants.com.

Reference: Zelek L, Bugat R, Cherqui D, et al. 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 Assocation for Research in Oncology trial).

Annals of Oncology. 2003;14:1537-1542.

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