Wanebo HJ1*, Sanikommu SR2, Taneja C3, Begossi G4, Belliveau J5 and Rathore R6
1Roger Williams Medical Center, USA
2Department of Surgery, Case Western Medical Center, USA
3Rhode Island Hospital, USA
4Alta Bates Summit Medical Center, USA
5Division of Surgical Oncology, Landmark Medical Center, USA
6Department of Medical Oncology, Roger Williams Medical Center, USA
Background: Previously treated Hepatic Colorectal Metastases (CRC) and advanced Hepato Cellular Cancer (HCC) are tumor challenges frequently unresponsive to systemic Chemo Therapy (CT). We reviewed survival outcome in chemo resistant/high risk patients following Hepatic Artery Infusion (HAI) in 21 CRC pts, 10 HCC pts, and 6 miscellaneous metastatic cancers.
Methods: Patient groups: 21 CRC pts, (16M, 5F), mean age 63, 16 had metachronous (DFI-17 mos), and 5 Synchronous CA; liver extent: 76% multiple (>5) mets or extensive bilateral, CEA (ng/m), >100, 8 pts >50 (3pts) and, NA - 7 pts. Previous CT: FU/LV (11 pts), Oxaliplatin (OX) or Irinotecan (IR) 10 pts. Liver surgery: Partial Resection/RFA - 9 pts. HCC 9 pts, cholangio CA 1 pt, M/F 5/5, average age 63. Previous RX Hepatic lobectomy + HAI were done in metastatic lung (1), Breast (1), advanced gallbladder (GBCA) (T3-4) (2 pts); HAI alone was done in Br CA (1) carcinoid (1). Treatment Protocols: CRC Protocol: HAI-FUDR 12-15mg/kg/d, dexamethasone 2mg/kg/d, Leukovorin 20mg/m2/d (14 d) plus bolus infusion (d1), Oxaliplatin (OX) 130mg/m2 (or Cisplatin (CIS) 100mg m2 d1); Systemic RX: d20-30. OX I>V. 130mg/m2, capecitabine 750-1000mg/m2/d x 10 days (also used in Miscel.Grp.). HCC Protocol: HAI-14 d as in CRC Protocol. Bolus infusion d1- doxorubicin 75mg/m2 or OX or CIS as in CRC schema.
Results: CRC: OS-CRC post start HAI was 17 mos, (2yr/5yr = 27%/6%). HCC OS was 7 mos. Median (3-12 mos in 9 evaluable pts; 1 HCC pt, with recurrence 2 yr. post hepatectomy was treated over 3.5 yrs. with HAI + RFA/TACE - (OS- 67mos). Miscellaneous group included lung (11 mos), Br CA (23, 9 mo) adv. carcinoid (3 mos), GBCA -2 pts >60 mos). Complications included infected pocket (2 pts) and duodenal fistula (1 pt).
Conclusion: Hepatic artery infusion alternating with systemic chemotherapy has apparent survival benefit in selected patients with persistent or progressive chemo resistant cancer from metastatic CRC, HCC or selected cancers (breast, lung, liver, gallbladder cancer) and warrants further study.
Wanebo HJ, Sanikommu SR, Taneja C, Begossi G, Belliveau J, Rathore R. Hepatic Artery Infusion for Recurrent or Chemo Resistant Hepatic Malignancy. Clin Oncol. 2017; 2: 1208.