INTRA-ARTERIAL CHEMOTHERAPY AS A CLINICAL OPTION FOR METASTATIC COLORECTAL CANCER: CONVERSION OF INOPERABLE LIVER METASTASES TO OPERABLE ILLUSTRATED WITH A CLINICAL CASE

Authors

  • K. Cherchenko State Non-commercial Enterprise “National Cancer Institute”, Kyiv, Ukraine
  • A. Lukashenko State Non-commercial Enterprise “National Cancer Institute”, Kyiv, Ukraine
  • Yu. Ostapenko State Non-commercial Enterprise “National Cancer Institute”, Kyiv, Ukraine
  • V. Patsko State Non-commercial Enterprise “National Cancer Institute”, Kyiv, Ukraine
  • M. Vinohradova State Non-commercial Enterprise “National Cancer Institute”, Kyiv, Ukraine
  • K. Valikhnovska State Non-commercial Enterprise “National Cancer Institute”, Kyiv, Ukraine
  • S. Pamanska State Non-commercial Enterprise “National Cancer Institute”, Kyiv, Ukraine

DOI:

https://doi.org/10.15407/exp-oncology.2023.04.515

Keywords:

metastatic colorectal cancer, liver metastasis, hepatic artery infusion, intra-arterial chemotherapy, conversion to respectability

Abstract

Colorectal cancer exerts a very high level of liver metastases, even on primary diagnosis, with 80%—90% unresectable nodules. At the same time, the possibility of resection has a significant impact on survival: 5-year survival is 6%—10% without liver surgery and up to 30% upon resection of liver metastases. Finding ways to improve resectability is a topical search for doctors all over the world. One of the promising methods to convert unresectable liver metastases of colorectal cancer into resectable ones is a hepatic artery infusion, or intra-arterial chemotherapy allowing for the delivery of cytotoxic drugs directly to the common hepatic artery via catheter or pump with decreased systemic toxicity and increased local drug concentration. In this article, we discuss the literature data on the impact of intra-arterial chemotherapy on the resectability of colorectal metastases in the liver and present the results of the successful clinical case. The literature shows a positive impact of the hepatic artery infusion on the resectability of hepatic metastases of colorectal cancer. The National Cancer Institute (Ukraine) has its own experience in hepatic artery infusion with further resection of primary-unresectable colorectal metastases in the liver. In our clinical case, a patient with liver-limited metastasis of colorectal cancer was initially inoperable due to the size of tumor lesions and an insufficient residual volume of the liver. Hepatic artery infusion tactics was chosen for this patient. The patient received six cycles of intra-arterial chemotherapy, namely five FOLFOX cycles and one 5-FU cycle, and then met the resectability criteria. Also, it is important to notice that the case demonstrates chemoresistance overcoming, since the patient had disease progression before, following systemically administered XELOX, and the period until readmission of the drugs was less than 6 months. So, hepatic artery infusion can be considered a promising method to convert unresectable liver metastases of colorectal cancer into resectable ones for highly selected patients.

References

Colorectal cancer statistics | WCRF International. WCRF International. URL: https://www.wcrf.org/cancer- trends/colorectal-cancer-statistics/ (date of access: 04.10.2022)

Fedorenko ZP, Goulak LO, Gorokh YeL, et al. Cancer in Ukraine 2020-2021: incidence, mortality, prevalence and other relevant statistics. Bull Nat Cancer Reg Ukraine 2022: 23. Available at http://www.ncru.inf.ua/publications/BULL_23/index_e.htm

Kolesnik O, Burlaka A, Lukashenko A, et al. Liver resection experience in metastatic colorectal cancer patients.

Clin Oncol. 2015;2:14-17 (in Ukrainian).

Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10-29. https://doi.org/10.3322/caac.20138

Sanoff HK, Sargent DJ, Campbell ME, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol. 2008;26(35):5721-5727. https://doi.org/10.1200/jco.2008.17.7147

Kemeny N, Jarnagin W, Paty P, et al. Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol. 2005;23(22):4888-4896. https://doi.org/10.1200/jco.2005.07.100

Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol. 1954;30(5):969-977.

Ensminger WD, Gyves JW. Clinical pharmacology of hepatic arterial chemotherapy. Semin Oncol. 1983;10(2):176-182.

Cherchenko K, Lukashenko A, Ostapenko Y, et al. Intra-arterial chemotherapy in metastatic colorectal cancer: a review of the literature and a clinical case. Clin Oncol. 2022;3-4(47-48):1-8. https://doi.org/10.32471/clinicaloncology.2663-466X.49-1.29873 (In Ukrainian).

Thiels CA, D'Angelica MI. Hepatic artery infusion pumps. J Surg Oncol. 2020;122(1):70-77. https://doi. org/10.1002/jso.25913

Ammori JB, Kemeny NE. Regional hepatic chemotherapies in treatment of colorectal cancer metastases to the liver. Semin Oncol. 2010;37:139-148. https://doi.org/10.1053/j.seminoncol.2010.03.003

Ensminger W, Niederhuber J, Dakhil S, et al. Totally implanted drug delivery system for hepatic arterial chemotherapy. Cancer Treat Rep. 1981;65:393-400.

Fong Y, Kemeny N, Paty P, et al. Treatment of colorectal cancer: Hepatic metastasis. Semin Surg Oncol. 1996;12:219–252. https://doi.org/10.1002/(SICI)1098-2388(199607/08)12:4<219::AID-SSU3>3.0.CO;2-8

Kemeny MM, Battifora H, Blayney DW, et al. Sclerosing cholangitis after continuous hepatic artery infusion of FUDR. Ann. Surg. 1985;202:176. https://doi.org/10.1097%2F00000658-198508000-00007

Kemeny NE, Melendez FD, Capanu M, et al. Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma. J Clin Oncol. 2009;27(21):3465-3471. https://doi.org/10.1200/jco.2008.20.1301

D’Angelica MI, Correa-Gallego C, Paty PB, et al. Phase II trial of hepatic artery infusional and systemic chemotherapy for patients with unresectable hepatic metastases from colorectal cancer: conversion to resection and long-term outcomes. Ann Surg. 2015;261(2):353-360. https://doi.org/10.1097/sla.0000000000000614

Kemeny N, Jarnagin W, Paty P, et al. Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol. 2005;23(22):4888-4896. https://doi.org/10.1200/jco.2005.07.100

Lorenz M, Müller HH. Randomized, multicenter trial of fluorouracil plus leucovorin administered either via epatic arterial or intravenous infusion versus fluorodeoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol. 2000;18(2):243-254. https://doi.org/10.1200/jco.2000.18.2.243

Ducreux M, Ychou M, Laplanche A, et al. Hepatic arterial oxaliplatin infusion plus intravenous chemotherapy in colorectal cancer with inoperable hepatic metastases: a trial of the gastrointestinal group of the Federation Nationale des Centres de Lutte Contre le Cancer. J Clin Oncol. 2005;23(22):4881-4887. https://doi.org/10.1200/ jco.2005.05.120

Boige V, Malka D, Elias D, et al. Hepatic arterial infusion of oxaliplatin and intravenous LV5FU2 in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure. Ann Surg Oncol. 2008;15(1):219-226. https://doi.org/10.1245/s10434-007-9581-7

Lévi FA, Boige V, Hebbar M, et al. Conversion to resection of liver metastases from colorectal cancer with hepatic artery infusion of combined chemotherapy and systemic cetuximab in multicenter trial OPTILIV. Ann Oncol. 2016;27(2):267-274. https://doi.org/10.1093/annonc/mdv548 33. NCCN Guidelines. Colon Cancer. Version 3.2021 – September 10, 2021

Downloads

Published

03.02.2024

How to Cite

Cherchenko, K., Lukashenko, A., Ostapenko, Y., Patsko, V., Vinohradova, M., Valikhnovska, K., & Pamanska, S. (2024). INTRA-ARTERIAL CHEMOTHERAPY AS A CLINICAL OPTION FOR METASTATIC COLORECTAL CANCER: CONVERSION OF INOPERABLE LIVER METASTASES TO OPERABLE ILLUSTRATED WITH A CLINICAL CASE. Experimental Oncology, 45(4), 515–522. https://doi.org/10.15407/exp-oncology.2023.04.515