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01-03-2008 | Hepatobiliary-Pancreas

Palliative hepatic intraarterial chemotherapy (HIC) using a novel combination of gemcitabine and mitomycin C: results in hepatic metastases

Authors: Thomas J. Vogl, Stephan Zangos, Katrin Eichler, J. Bayne Selby, Ralf W. Bauer

Published in: European Radiology | Issue 3/2008

Abstract

To evaluate repeated hepatic intraarterial chemotherapy (HIC) as a palliative treatment option for unresectable cholangiocarcinoma and liver metastases of various origins that were progressive under systemic chemotherapy. Between 2002 and 2006, 55 patients were treated in 4-week intervals (mean five sessions). Combined gemcitabine/mitomycin was administered intraarterially within 1 h. Tumor response was evaluated after the third session according to RECIST. Treated tumor entities were colorectal carcinoma (CRC) (n = 12), breast cancer (BC) (n = 12), cholangiocarcinoma (CCC) (n = 10), pancreatic (n = 4), ovarian (n = 3), gastric, cervical, papillary (each n = 2), prostate, esophageal carcinoma, leiomyosarcoma (each n = 1), cancer of unknown primacy (CUP) (n = 5). All patients tolerated the treatment well without any major side effects or complications. In total, there were 1 complete response (CR), 19 partial responses (PR), 19 stable (SD) and 16 progressive diseases (PD). We observed 5 PR, 3 SD and 4 PD in CRC; 1 CR, 4 PR, 6 SD in BC; and 2 PR, 2 SD and 6 PD in CCC. Median survival after first HIC was 9.7 months for CRC, 11.4 months for BC and 6.0 months for CCC. HIC with gemcitabine/mitomycin is a safe, minimally invasive, palliative treatment for hepatic metastases that are progressive under systemic chemotherapy. The treatment yields respectable tumor control rates in CRC and BC patients.

Nucum S, Midgley R, Kerr DJ (2003) Colorectal cancer. Acta Oncol 42(4):263–275CrossRef

Eichbaum MHR, Kaltwasser M, Bruckner T, de Rossi TM, Schneeweiss A, Sohn Ch (2006) Prognostic factors for patients with liver metastases from breast cancer. Breast Cancer Res Treat 96(1):53–62PubMedCrossRef

Heinemann V, Artmann A, Beinert T, Dietzfelbinger H, Eiermann W, Gabius S, Harbeck N, Kahlert S, Kau W, Lombardo SM, Lorenz T, Merz P, Pihusch R, Rauthe C, Sattler D, Sauer H, Untch M, Wolf C (2005) Systemische Therapie des metastasierten Mammakarzinoms. In: Sauer H, Tumorzentrum Muenchen (ed) Mammakarzinome - Empfehlungen zur Diagnostik, Therapie und Nachsorge. Zuckschwerdt, Muenchen, pp 225–241

Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366:1303–1314PubMedCrossRef

Anderson CD, Pinson CW, Berlin J, Chari RS (2004) Diagnosis and treatment of cholangiocarcinoma. Oncologist 9:43–57PubMedCrossRef

Hejna M, Pruckmayer M, Raderer M (1998) The role of chemotherapy and radiation in the management of biliary cancer: a review of the literature. Eur J Cancer 34(7):977–986PubMedCrossRef

Vogl TJ, Zangos S, Eichler K, Yakoub D, Nabil M (2007) Colorectal liver metastases: regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: an update. Eur Radiol 17(4):1025–1034PubMedCrossRef

Dedrick RL (1988) Arterial drug infusion: pharmacokinetic problems and pitfalls. J Natl Cancer Inst 80:84–89PubMedCrossRef

Stephens FO (1983) Pharmacokinetics of intraarterial chemotherapy. Recent Results Cancer Res 86:1–12PubMed

10.

Chen HSG, Gross JF (1980) Intraarterial infusion of anticancer drugs: theoretic aspects of drug delivery and review of responses. Cancer Treat Rep 64:31–40PubMed

11.

Schneider A, Kemeny N, Chapman D, Niedzwiecki D, Odermann P (1989) Intrahepatic mitomycin C as a salvage treatment for patients with hepatic metastases from colorectal cancer. Cancer 64:2203–2206PubMedCrossRef

12.

Therasse P, Arbuck SG, Eisenhauer E, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian CM, Gwyther SG (2000) New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 92:205–216PubMedCrossRef

13.

Damjanovic D, Thompson P, Findlay MPN (2004) Evidence-based update of chemotherapy options for metastatic colorectal cancer. ANZ J Surg 74:781–787PubMedCrossRef

14.

Lawes D, Taylor I (2005) Chemotherapy for colorectal cancer—an overview of current management for surgeons. Eur J Surg Oncol 31(9):932–941PubMedCrossRef

15.

Hurwitz H, Kabbinavar F (2005) Bevacizumab combined with standard fluoropyrimidine-based chemotherapy regimens to treat colorectal cancer. Oncology 69(Suppl 3):17–24PubMedCrossRef

16.

Noble S, Goa KL (1997) Gemcitabine—a review of its pharmacology and clinical potential in non-small lung cancer and pancreatic cancer. Drugs 54(3):447–472PubMedCrossRef

17.

Burris HA, Moore MJ, Anderson J, Green MR, Rothenberg ML, Modiano MR, Cripps MC, Portenoy RK, Storniolo AM, Tarassoff P, Nelson F, Dorr FA, Stephens CD, Von Hoff DD (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15(6):2403–2413PubMed

18.

Kemeny N, Eid A, Stockman J, Gonen M, Schwartz L, Tetzlaff E, Paty P (2005) Hepatic arterial infusion of floxuridine and dexamethasone plus high-dose mitomycin C for patients with unresectable hepatic metastases from colorectal carcinoma. J Surg Oncol 91:97–101PubMedCrossRef

19.

Kemeny NE, Niedzwiecki D, Hollis DR, Lenz HJ, Warren RS, Naughton MJ, Weeks JC, Sigurdson ER, Herndon JE, Zhang C, Mayer RJ (2006) Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life, and molecular markers (CALGB 9481). J Clin Oncol 24:1395–1403PubMedCrossRef

20.

Kemeny N, Jarnagin W, Paty P, Gönen M, Schwartz L, Morse M, Leonard G, D’Agnelica M, DeMatteo R, Blumgart L, Fong Y (2005) Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol 23:4888–4896PubMedCrossRef

21.

Ducreux M, Ychou M, Laplanche A, Gamelin E, Lasser P, Husseini F, Quenet F, Viret F, Jacob JH, Boige V, Elias D, Delperro JR, Luboinski M (2005) Hepatic arterial oxaliplatin infusion plus intravenous chemotherapy in colorectal cancer with inoperable hepatic metastases: a trial of the Gastrointestinal Group of the Fédération Nationale des Centres de Lutte Contre le Cancer. J Clin Oncol 23:4881–4887PubMedCrossRef

22.

Solomayer EF, Diel IJ, Meyberg GC, Gollan C, Bastert G (2000) Metastatic breast cancer: clinical course, prognosis and therapy related to the first site of metastasis. Breast Cancer Res Treat 59:271–278PubMedCrossRef

23.

Insa A, Lluch A, Prosper F, Marugan I, Martinez-Agullo A, Garcia-Conde J (1999) Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients. Breast Cancer Res Treat 56:67–78PubMedCrossRef

24.

Elder EE, Kennedy CW, Gluch L, Carmalt HL, Janu NC, Joseph MG, Donellan MJ, Molland JG, Gilett DJ (2006) Patterns of breast cancer relapse. Eur J Surg Oncol. DOI 10.1016/j.ejso.2006.06.001

25.

Okaro AC, Durkin DJ, Layer GT, Kissin MW, Karanjia ND (2005) Hepatic resection for breast cancer metastases. Ann R Coll Surg Engl 87:167–170PubMedCrossRef

26.

Elias D, Maisonnette F, Druet-Cabanac M, Ouellet JF, Guinebretiere JM, Spielmann M, Delaloge S (2003) An attempt to clarify indications for hepatectomy for liver metastases from breast cancer. Am J Surg 185:158–164PubMedCrossRef

27.

Maksan SM, Lehnert T, Bastert G, Herfarth C (2000) Curative liver resection for metastatic breast cancer. Eur J Surg Oncol 26:209–212PubMedCrossRef

28.

Pestalozzi BC (2006) Mammakarzinom - therapeutische Fortschritte. Ther Umschau 63(4):255–261CrossRef

29.

O’Shaughnessy J (2005) Extending survival with chemotherapy in metastatic breast cancer. Oncologist 10:20–29PubMedCrossRef

30.

Ikeda T, Adachi I, Takashima S, Ogita M, Aoyama H, Sano M, Ando J, Tabei T, Tominaga T, Enomoto K, Kanda K, Fukutomi T, Shimoyama M (1999) A phase I/II study of continous intra-arterial chemotherapy using an implantable reservoir for the treatment of liver metastases from breast cancer: a Japan Clinical Oncology Group (JCOG) Study 9113. Jpn J Clin Oncol 29(1):23–27PubMedCrossRef

31.

Arai Y, Sone Y, Inaba Y, Ariyoshi Y, Kido C (1994) Hepatic arterial infusion chemotherapy for liver metastases from breast cancer. Cancer Chemother Pharmacol 33:142–144CrossRef

32.

Lorenz M, Wiesener J, Staib-Sebler E, Encke A (1995) Regional therapy breast cancer liver metastases. Zentralbl Chir 120(10):786–790PubMed

33.

Zimmermann T, Flechsenhar K, Padberg W (1998) Value of locoregional chemotherapy in liver metastases of breast carcinoma. Zentralbl Chir 123(suppl 5):159–161PubMed

34.

Schneebaum S, Walker MJ, Young D, Farrar WB, Minton JP (1994) The regional treatment of liver metastases from breast cancer. J Surg Oncol 55(1):26–32PubMedCrossRef

35.

Thongprasert S (2005) The role of chemotherapy in cholangiocarcinoma. Ann Oncol 16 (suppl 2):93–96

36.

Klebl F, Endlicher E, Kullmann F (2006) Palliative Therapie von Gallengangs- und Gallenblasenkarzinomen. Z Gastroenterol 44:587–598PubMedCrossRef

37.

Tanaka N, Yamakado K, Nakatsuka A, Fujii A, Matsumura K, Takeda K (2001) Arterial chemoinfusion therapy through an implanted port system for patients with unresectable intrahepatic cholangiocarcinoma - initial experience. Eur J Radiol 41:42–48CrossRef

38.

Cantore M, Mambrini A, Fiorentini G, Rabbi C, Amagni D, Caudana R, Pennucci C, Sanguinetti F, Lombardi M, Nicoli N (2005) Phase II study of hepatic intraarterial epirubicin and cisplatin, with systemic 5-fluorouracil in patients with unresectable biliary tract tumors. Cancer 103:1402–1407PubMedCrossRef

39.

Burger I, Hong K, Schulick R, Georgiades C, Thuluvath P, Choti M, Kamel I, Geschwind JFH (2005) Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experiences in a single institution. J Vasc Interv Radiol 16:353–361PubMed

40.

Vogl TJ, Schwarz W, Eichler K, Hochmuth K, Hammerstingl R, Jacob U, Scheller A, Zangos S, Heller M (2006) Hepatic intraarterial chemotherapy with gemcitabine in patients with unresectable cholangiocarcinomas and liver metastases of pancreatic cancer: a clinical study on maximum tolerable dose and treatment efficacy. J Cancer Res Clin Oncol. DOI 10.1007/s00432-006-0138-0

41.

Burris HA (1996) Objective outcome measures of quality of life. Oncology (Williston Park) 10(Suppl 11):131–135

Title: Palliative hepatic intraarterial chemotherapy (HIC) using a novel combination of gemcitabine and mitomycin C: results in hepatic metastases
Authors: Thomas J. Vogl
Stephan Zangos
Katrin Eichler
J. Bayne Selby
Ralf W. Bauer
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: European Radiology / Issue 3/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-007-0781-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Palliative hepatic intraarterial chemotherapy (HIC) using a novel combination of gemcitabine and mitomycin C: results in hepatic metastases

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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