Hepatic Arterial Infusion of Oxaliplatin and L-Folinic Acid-modulated 5-Fluorouracil for Colorectal Cancer Liver Metastases

Abstract

Background: Despite the progress made in the treatment of metastatic colorectal cancer (CRC), the results of second-line chemotherapy remain poor. Patients and Methods: The feasibility of hepatic arterial infusion (HAI) of oxaliplatin (100 mg/m² over 6 h) followed by l-folinic acid (L-FA) (400 mg over 2 h i.v.)-modulated continuous HAI of 5-Fluorouracil (5-FU) (60 mg/kg over 42 h; q2w) as second-line chemotherapy for metastatic CRC limited to the liver was investigated. Results: A median of 9 treatment cycles were administered (range 4-14). Treatment-limiting toxicity consisted of: abdominal pain (3 patients), elevated liver enzymes accompanied by fatigue (3), elevated bilirubin (2), neutropenia (2), thrombocytopenia (3) and hypersensitivity to oxaliplatin (1). Normalization for >4 weeks of the carcinoembryonic antigen (CEA) level was documented in 3 patients and a decline of >50% for >4 weeks in 5 patients. A confirmed partial response (PR) was documented in 5, stable disease (SD) in 1 and progressive disease (PD) in 3 patients. In the latter 3 patients, lung metastases developed while a PR was observed in the liver metastases. A pathological complete response (CR) was documented in 2 patients. The median time to progression was 7.2 months (95% CI 1.3-13) and the median overall survival 18.3 months (95% CI 16.3-20.3). Conclusion: HAI of oxaliplatin plus CI5-FU/LV is feasible and merits further evaluation.