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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2023

28-08-2023 | Metastasis | Hepatobiliary Tumors

Combined Hepatic Arterial Infusion Pump and Systemic Chemotherapy in the Modern Era for Chemotherapy-Naive Patients with Unresectable Colorectal Liver Metastases

Authors: Floris S. Verheij, BSc, Koert F. D. Kuhlmann, MD, PhD, Danielle R. Silliman, MA, Kevin C. Soares, MD, T. Peter Kingham, MD, FACS, Vinod P. Balachandran, MD, Jeffrey A. Drebin, MD, PhD, Alice C. Wei, MD, William R. Jarnagin, MD, FACS, Andrea Cercek, MD, Niels F. M. Kok, MD, PhD, Nancy E. Kemeny, MD, Michael I. D’Angelica, MD, FACS

Published in: Annals of Surgical Oncology | Issue 13/2023

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Abstract

Purpose

Chemotherapy-naive patients with unresectable colorectal liver metastases (CRLM) have been the best responders to hepatic arterial infusion (HAI) therapy. The current treatment paradigm has drifted away from HAI in the first-line setting. We aimed to analyze outcomes of combined first-line systemic therapy with HAI therapy (HAI+SYS) in the modern era.

Methods

We conducted a retrospective study of consecutive chemotherapy-naive patients with unresectable CRLM who received HAI+SYS between 2003 and 2019. Patients were selected from a prospectively maintained database. Outcomes included radiological response rate, conversion to resection (CTR) rate, and overall survival (OS).

Results

Fifty-eight chemotherapy-naive patients were identified out of 546 patients with unresectable CRLM managed with HAI. After induction treatment, 4 patients (7%) had a complete radiological response, including two durable responses. In total, 32 patients (55%) underwent CTR. CTR or complete response without resection was achieved after seven cycles of systemic therapy and four cycles of HAI therapy. Median OS for the whole cohort was 53.0 months (95% confidence interval 23.0–82.9). Three- and 5-year OS in patients who achieved CTR or complete response versus patients who did not was 88% and 72% versus 27% and 0% respectively. Of patients who underwent CTR, complete and major pathological response (no and <10% viable tumor cells, respectively) was observed in 7 (22%) and 12 patients (38%).

Conclusions

Combined HAI+SYS in chemotherapy-naive patients resulted in durable and substantial response in a large proportion of patients. Nearly two-thirds of patients achieved a complete response or proceeded to conversion surgery, which was associated with prolonged survival.
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Metadata
Title
Combined Hepatic Arterial Infusion Pump and Systemic Chemotherapy in the Modern Era for Chemotherapy-Naive Patients with Unresectable Colorectal Liver Metastases
Authors
Floris S. Verheij, BSc
Koert F. D. Kuhlmann, MD, PhD
Danielle R. Silliman, MA
Kevin C. Soares, MD
T. Peter Kingham, MD, FACS
Vinod P. Balachandran, MD
Jeffrey A. Drebin, MD, PhD
Alice C. Wei, MD
William R. Jarnagin, MD, FACS
Andrea Cercek, MD
Niels F. M. Kok, MD, PhD
Nancy E. Kemeny, MD
Michael I. D’Angelica, MD, FACS
Publication date
28-08-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14073-3

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