Two consecutive clinical trials on cisplatin (CDDP), hepatic arterial infusion (HAI), and I.V. 5-fluorouracil (5-FU) chemotherapy for unresectable colorectal liver metastases: An alternative to FUdR-based regimens?

Abstract

Several phase III clinical trials demonstrated that hepatic arterial chemotherapy for unresectable colorectal liver metastases is able to provide significantly higher response rates than those obtained by systemic route: in more than 500 patients collected from 6 randomized trials, the median values of objective response rates were 55% after fluoxuridine (FUdR) continuous hepatic arterial infusion (HAI) vs. 18.5% after FUdR or 5-fluorouracil (5-FU) intravenous (i.v.) chemotherapy. Furthermore, the majority of those studies reported that median survival increased in the patient subgroups treated with intrahepatic chemotherapy, even if not always statistically significant [1-6]. Certainly, FUdR can be recognized as the first drug, among those regionally given, able to modify the natural history of colorectal liver metastases: it results from both the highest rates of objective responses ever reported in literature and the almost constant notice of unusual sites of extrahepatic metastases [7-10].