Liver metastases after colonic carcinoma—palliative chemotherapy plus curcumin

Abstract

Dear Editor: New treatment modalities were developed in the recent years for liver metastases after curative resection of colonic cancer in elderly patients. Here, we highlight an antineoplastic effect of curcumin in the diagnosis of an advanced stadium (liver metastases) after curative colonic resection due to cancer. We emphasize on the therapeutic options and on the role of oral intake of curcumin in the treatment of this entity. A 79-year-old woman was referred to an external Department of Visceral Surgery with a gradually progressing large-bowel obstruction. The colonoscopy revealed a large polypoid adenocarcinoma of the sigmoid colon. No metastases were detected. The patient was then referred for further open curative colonic resection. Surgery was performed (pT3, pN1, G3, R0, L0, V0, M0). Due to a superficial wound healing disorder, the postoperative recovery was slightly prolonged. No other complications occurred. An adjuvant chemotherapy was performed according to the MAYO protocol. Chemotherapy was interrupted due to adverse effects (severe elevated liver enzymes, cardiac circulation disorder). In the follow-up, five diffuse liver metastases were detected 24 months after primary resection (between 28 and 48 mm in diameter) in the CT scan. The CEA value was elevated (53 μg/l). Therefore, an intravenous palliative chemotherapy was initiated. Due to the patient’s reduced general conditions, only a 75% dose was applied compared to the regular protocol (oxaliplatin 37.5mg/m, sodiumfolinat 150 mg/m, and 5-FU 1,500 mg/m). As a consequence of the present literature and our own research, curcumin, a novel antineoplastic mean, was additionally orally given once a day with a dose of 5,000 mg. After 5 months, a clear regression of the liver metastases could be noticed. The three subphrenical metastases showed a diameter of 12 mm—which is a reduction by 50%. The metastasis in the lobus caudatus reduced from 28 to 12 mm, whereas the lesion in liver segment 6 condensed from 37 to 13 mm. The current CEA value is 10 μg/l. However, due to the relevant side effects of oxaliplatin (severe dysesthesia), traditional chemotherapy for the patient has been interrupted after three cycles (3 months). Curcumin has been taken since palliative treatment was started. Although it is not clear whether the observed anti-tumor effects might be mainly attributed to the intravenous palliative chemotherapy or the antineoplastic impact of curcumin, results of their combination seem to be interesting. Curcumin has been shown to have potent anti-metastatic activity in vitro and in vivo. It acts as an inhibitor of kinases and, therefore, influences important signaling pathways involved in inflammation and angiogenesis. Curcumin suppresses the growth of different tumor cells in culture, prevents carcinogen-induced cancers in rodents, and affects the growth of human tumors in xenotransplant or orthotransplant animal models either alone or in combination with chemotherapeutic agents or radiation. To the authors’ knowledge, numerous phase I and phase II clinical trials indicate that curcumin is safe and may exhibit therapeutic antineoplastic efficacy. In current studies, inhibition Int J Colorectal Dis (2009) 24:859–860 DOI 10.1007/s00384-009-0651-0