Hepatic Arterial Therapy for First-Line Treatment of Unresectable Colorectal Liver Metastases: What We Know in the Wake of Two Recent Randomized Control Trials

Excerpt

The most common site of metastatic disease from colorectal cancer is the liver, and liver disease frequently dictates the prognosis. Therefore, it is sensible to be aggressive in treating colorectal liver metastases (CRLM). Surgical resection is the only chance of long-term disease control (5-year survival 25 to 58 %), but only about 25 % of the cases are deemed resectable at the time of presentation. For unresectable cases, systemic therapy is the standard-of-care for the initial first-line therapy. Unfortunately, those treated with systemic therapy will invariably develop dose-limiting toxicities or will progress leaving less responsive 2nd line and 3rd line options for disease control. HAT (chemoembolization or radioembolization) is commonly used in this clinical setting, and it has been shown to provide benefit in that regard [1]. HAT consists of the placement of a catheter into the hepatic artery through a femoral artery access site. Through the catheter, drug-eluting beads loaded with irinotecan (DEBIRI) or beads loaded with the radioactive yttrium 90 (⁹⁰Y) isotope are delivered to the target liver lesions by taking advantage of differential perfusion (CRLMs and most liver tumors are preferentially perfused by the hepatic artery). As a result, HAT aggressively treats liver tumor burden with minimal collateral damage and systemic toxicity. …