Hepatic artery infusion for recurrent or chemoresistant hepatic malignancy.

Abstract

351 Background: Previously treated hepatic colorectal metastases (CRC) and advanced hepatocellular cancer (HCC) are tumor challenges frequently unresponsive to systemic chemotherapy (CT). We reviewed survival outcome in chemoresistant/high-risk patients following hepatic artery infusion (HAI) in 21 CRC pts, 10 HCC pts, and 6 miscellaneous metastatic cancers. Methods: Patient groups: 21 CRC pts (16 M, 5 F), mean age 63, 16 had metachronous (DFI-17 mos), and 5 synchronous CA; liver extent: 76% multiple (>5) mets or extensive bilateral, CEA (ng/m), >100, 8 pts > 50 (3 pts) < 5 (3 pts) and NA = 7 pts. Previous CT:FU/LV (11pts), oxaliplatin (OX) or irinotecan (IR) (10 pts). Liver surgery: partial resection/RFA = 9 pts. HCC = 9 pts, cholangio CA (1), M/F 5/5; av. age 63. Previous RX hepatic lobectomy 4 pts, RFA/TACE = 3 patients. Miscellaneous GP (therapy): hepatic lobectomy + HAI were done in metastatic lung (1), breast (1), advanced gall bladder cancer (GBCA) (T 3-4) (2 pts); HAI alone was done in Br. CA (1) carcinoid (1) treatment protocols: CRC protocol: HAI-FUDR 12-15 mg/kg/d, dexamethasone 2mg.kg/d, leucovorin 20 mg/m2 /d (14 d) plus bolus infusion (d1), oxaliplatin (OX) 130 mg/m2 (or cisplatin (CIS) 100 mg/m2 d1); systemic RX: d20-30. OX I.V. 130 mg/m2, capecitabine 750-1,000 mg/m2/d x 10 days (also used in Miscel. Grp.) HCC Protocol: HAI-14 d as in CRC Protocol. Bolus infusion d1-doxorubicin 75 mg/m2 or OX or CIS as in CRC schema. Results: CRC:OS-CRC post start HAI = med/16mos., 2yr/5yr = 27%/6%. HCC OS = 9 mos. Median (3-12 mos in 9 evaluable pts.; 1 HCC pt, with recurrence 2 yr. post central hepatectomy was treated over 3.5 yrs. with HAI + RFA/TACE – (OS-67mo). Miscellaneous group included lung (11 mos) Br CA (23, 9 mos) adv. Carcinoid (3 mos), GBCA (2 pts > 60 mos). Major complications: pump malfunction (4 pts), misperfusion (2) pts, infected pocket (2) pts, duodenal fistula (1) pt. Conclusions: Hepatic artery infusion alternating with systemic chemo therapy has apparent survival benefit in selected patients with persistent or progressive chemo resistant malignancy from metastatic CRC, HCC, or selected miscellaneous cancers (breast, lung, liver, gall bladder cancer) and warrants further study. No significant financial relationships to disclose.