NEW YORK (Reuters Health) – Combining hepatic artery infusion of floxuridine/dexamethasone with systemic oxaliplatin and irinotecan can make liver metastases from colorectal cancer resectable in about half of patients.

The findings, reported in the May 26th issue of the Journal of Clinical Oncology, are based on a study of 49 patients, 23 of whom had never been treated with chemotherapy before.

Lead author Dr. Nancy E. Kemeny, from Memorial Sloan-Kettering Cancer Center, New York, told Reuters Health that while the present study is not the first to examine treatments to increase resectability, it is different from many of its predecessors in that the subjects truly had unresectable disease.

“In many other studies using chemotherapy prior to resection…some of the patients really were resectable at first or did not have very extensive disease,” she explained. “For example, some studies used six metastases as a reason that the patient can not go to resection.”

By contrast, the patients in the current study, she noted, were clearly unresectable: 95% had 6 or more liver segments involved with tumor, 98% had bilobar disease, 89% had lesions greater than 5 cm, and 72% had synchronous disease.

Eight percent of patients had a complete treatment response and 84% had a partial response, the authors note. The overall conversion to resectability was 47%, while the rate in chemotherapy-naïve patients was 57%.

The median survival periods from the initiation of hepatic artery infusion for patients with and without prior chemotherapy exposure were 35 and 50.8 months, respectively. Female gender was the only baseline characteristic that predicted resectability. Variables indicting the extent of anatomic disease did not predict resectability.

Dr. Kemeny said that future research should examine whether systemic therapy alone could achieve the same results seen in the present study.

Reference:
J Clin Oncol 2009;27.