A new chemoembolization protocol in refractory liver metastasis of colorectal cancer - A feasibility study

W. Voigt, C. Behrmann, A. Schlueter, T. Kegel, Axel F Grothey, H. J. Schmoll

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Introduction: In patients with advanced colorectal cancer (CRC) refractory to systemic chemotherapy including 5-fluorouracil (5-FU) / folinic acid (FA), oxaliplatin and irinotecan we assessed the feasibility, toxicity and response to hepatic transcatheter arterial chemoembolization (TACE). At the time of treatment, patients had exclusively or dominantly liver metastasis of CRC. Patients and Methods: The following protocol was applied via a selective transfemoral hepatic arterial approach: mitomycin C 5 mg/m2, interferon-α2b 4.5 Mio IU, dexamethasone 20 mg mixed with Amilomer DSM 45/25 (Spherex®) days 1 and 2 i.a. (bolus), oxaliplatin 50 mg/m2 (2 h) day 1 i.a., FA 500 mg/m2 (2 h) day 1 i.v., and 5-FU 1.500 mg/m2 (24 h) day 1 i.a. Cycles have been repeated at days 15-22. The dose was adjusted according to the pretreatment performance status and elevation of alkaline phosphatase, bilirubin and serum albumin. Treatment was continued until progression or emergence of intolerable toxicity. Results: 11 patients received a total number of 43 TACE, with a range of 2-6 per patient. There was no TACE-related mortality. 4 patients died 5, 8, 10 and 11 months after initiation of treatment due to progression of disease. 7 patients are alive at 4+ (n = 2), 5+ (n = 1), 6+ (n = 1), 7+ (n = 1) and 11+ (n = 2) months after start of treatment. Toxicity (CTC) was mild with grade I-II asthenia (n = 10), grade I-II neurotoxicity (n = 5), grade II nausea and/or vomiting (n = 2) and grade II diarrhea (n = 1). Treatment had to be postponed due to grade I thrombocytopenia in 2 patients. No bleeding episodes or obvious infectious complications occurred during treatment intervals. 1 patient experienced an allergic reaction to oxaliplatin which led to exclusion from further therapy. Arterial catheter dislocation occurred in 3 patients. In 10 patients evaluable for response we observed 3 partial responses, 2 minor responses, and 4 times stable disease. Only 1 patient had further progression of disease under treatment. Conclusion: TACE, using a combination of mitomycin C, dexamethasone and interferon-α2b mixed with Spherex®, followed by oxaliplatin, FA and 5-FU, appears to be an effective and feasible treatment option in the case of liver metastasis of CRC refractory to standard systemic chemotherapy. This treatment is associated with tolerable toxicity, which becomes apparent mainly as asthenia, neurotoxicity or thrombocytopenia. These preliminary data warrant further evaluation for patients with refractory disease and would probably also be of interest for first-line treatment in this patient population.

Original languageEnglish (US)
Pages (from-to)158-164
Number of pages7
JournalOnkologie
Volume25
Issue number2
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Feasibility Studies
Colorectal Neoplasms
oxaliplatin
Neoplasm Metastasis
Liver
Leucovorin
Therapeutics
Fluorouracil
Asthenia
irinotecan
Mitomycin
Interferons
Dexamethasone
Disease Progression
Drug Therapy
Bilirubin
Serum Albumin
Thrombocytopenia
Nausea
Vomiting

Keywords

  • Colorectal cancer
  • Hepatic transcatheter arterial chemoembolization (TACE)

ASJC Scopus subject areas

  • Oncology

Cite this

Voigt, W., Behrmann, C., Schlueter, A., Kegel, T., Grothey, A. F., & Schmoll, H. J. (2002). A new chemoembolization protocol in refractory liver metastasis of colorectal cancer - A feasibility study. Onkologie, 25(2), 158-164. https://doi.org/10.1159/000055226

A new chemoembolization protocol in refractory liver metastasis of colorectal cancer - A feasibility study. / Voigt, W.; Behrmann, C.; Schlueter, A.; Kegel, T.; Grothey, Axel F; Schmoll, H. J.

In: Onkologie, Vol. 25, No. 2, 2002, p. 158-164.

Research output: Contribution to journalArticle

Voigt, W, Behrmann, C, Schlueter, A, Kegel, T, Grothey, AF & Schmoll, HJ 2002, 'A new chemoembolization protocol in refractory liver metastasis of colorectal cancer - A feasibility study', Onkologie, vol. 25, no. 2, pp. 158-164. https://doi.org/10.1159/000055226
Voigt, W. ; Behrmann, C. ; Schlueter, A. ; Kegel, T. ; Grothey, Axel F ; Schmoll, H. J. / A new chemoembolization protocol in refractory liver metastasis of colorectal cancer - A feasibility study. In: Onkologie. 2002 ; Vol. 25, No. 2. pp. 158-164.
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abstract = "Introduction: In patients with advanced colorectal cancer (CRC) refractory to systemic chemotherapy including 5-fluorouracil (5-FU) / folinic acid (FA), oxaliplatin and irinotecan we assessed the feasibility, toxicity and response to hepatic transcatheter arterial chemoembolization (TACE). At the time of treatment, patients had exclusively or dominantly liver metastasis of CRC. Patients and Methods: The following protocol was applied via a selective transfemoral hepatic arterial approach: mitomycin C 5 mg/m2, interferon-α2b 4.5 Mio IU, dexamethasone 20 mg mixed with Amilomer DSM 45/25 (Spherex{\circledR}) days 1 and 2 i.a. (bolus), oxaliplatin 50 mg/m2 (2 h) day 1 i.a., FA 500 mg/m2 (2 h) day 1 i.v., and 5-FU 1.500 mg/m2 (24 h) day 1 i.a. Cycles have been repeated at days 15-22. The dose was adjusted according to the pretreatment performance status and elevation of alkaline phosphatase, bilirubin and serum albumin. Treatment was continued until progression or emergence of intolerable toxicity. Results: 11 patients received a total number of 43 TACE, with a range of 2-6 per patient. There was no TACE-related mortality. 4 patients died 5, 8, 10 and 11 months after initiation of treatment due to progression of disease. 7 patients are alive at 4+ (n = 2), 5+ (n = 1), 6+ (n = 1), 7+ (n = 1) and 11+ (n = 2) months after start of treatment. Toxicity (CTC) was mild with grade I-II asthenia (n = 10), grade I-II neurotoxicity (n = 5), grade II nausea and/or vomiting (n = 2) and grade II diarrhea (n = 1). Treatment had to be postponed due to grade I thrombocytopenia in 2 patients. No bleeding episodes or obvious infectious complications occurred during treatment intervals. 1 patient experienced an allergic reaction to oxaliplatin which led to exclusion from further therapy. Arterial catheter dislocation occurred in 3 patients. In 10 patients evaluable for response we observed 3 partial responses, 2 minor responses, and 4 times stable disease. Only 1 patient had further progression of disease under treatment. Conclusion: TACE, using a combination of mitomycin C, dexamethasone and interferon-α2b mixed with Spherex{\circledR}, followed by oxaliplatin, FA and 5-FU, appears to be an effective and feasible treatment option in the case of liver metastasis of CRC refractory to standard systemic chemotherapy. This treatment is associated with tolerable toxicity, which becomes apparent mainly as asthenia, neurotoxicity or thrombocytopenia. These preliminary data warrant further evaluation for patients with refractory disease and would probably also be of interest for first-line treatment in this patient population.",
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AU - Behrmann, C.

AU - Schlueter, A.

AU - Kegel, T.

AU - Grothey, Axel F

AU - Schmoll, H. J.

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N2 - Introduction: In patients with advanced colorectal cancer (CRC) refractory to systemic chemotherapy including 5-fluorouracil (5-FU) / folinic acid (FA), oxaliplatin and irinotecan we assessed the feasibility, toxicity and response to hepatic transcatheter arterial chemoembolization (TACE). At the time of treatment, patients had exclusively or dominantly liver metastasis of CRC. Patients and Methods: The following protocol was applied via a selective transfemoral hepatic arterial approach: mitomycin C 5 mg/m2, interferon-α2b 4.5 Mio IU, dexamethasone 20 mg mixed with Amilomer DSM 45/25 (Spherex®) days 1 and 2 i.a. (bolus), oxaliplatin 50 mg/m2 (2 h) day 1 i.a., FA 500 mg/m2 (2 h) day 1 i.v., and 5-FU 1.500 mg/m2 (24 h) day 1 i.a. Cycles have been repeated at days 15-22. The dose was adjusted according to the pretreatment performance status and elevation of alkaline phosphatase, bilirubin and serum albumin. Treatment was continued until progression or emergence of intolerable toxicity. Results: 11 patients received a total number of 43 TACE, with a range of 2-6 per patient. There was no TACE-related mortality. 4 patients died 5, 8, 10 and 11 months after initiation of treatment due to progression of disease. 7 patients are alive at 4+ (n = 2), 5+ (n = 1), 6+ (n = 1), 7+ (n = 1) and 11+ (n = 2) months after start of treatment. Toxicity (CTC) was mild with grade I-II asthenia (n = 10), grade I-II neurotoxicity (n = 5), grade II nausea and/or vomiting (n = 2) and grade II diarrhea (n = 1). Treatment had to be postponed due to grade I thrombocytopenia in 2 patients. No bleeding episodes or obvious infectious complications occurred during treatment intervals. 1 patient experienced an allergic reaction to oxaliplatin which led to exclusion from further therapy. Arterial catheter dislocation occurred in 3 patients. In 10 patients evaluable for response we observed 3 partial responses, 2 minor responses, and 4 times stable disease. Only 1 patient had further progression of disease under treatment. Conclusion: TACE, using a combination of mitomycin C, dexamethasone and interferon-α2b mixed with Spherex®, followed by oxaliplatin, FA and 5-FU, appears to be an effective and feasible treatment option in the case of liver metastasis of CRC refractory to standard systemic chemotherapy. This treatment is associated with tolerable toxicity, which becomes apparent mainly as asthenia, neurotoxicity or thrombocytopenia. These preliminary data warrant further evaluation for patients with refractory disease and would probably also be of interest for first-line treatment in this patient population.

AB - Introduction: In patients with advanced colorectal cancer (CRC) refractory to systemic chemotherapy including 5-fluorouracil (5-FU) / folinic acid (FA), oxaliplatin and irinotecan we assessed the feasibility, toxicity and response to hepatic transcatheter arterial chemoembolization (TACE). At the time of treatment, patients had exclusively or dominantly liver metastasis of CRC. Patients and Methods: The following protocol was applied via a selective transfemoral hepatic arterial approach: mitomycin C 5 mg/m2, interferon-α2b 4.5 Mio IU, dexamethasone 20 mg mixed with Amilomer DSM 45/25 (Spherex®) days 1 and 2 i.a. (bolus), oxaliplatin 50 mg/m2 (2 h) day 1 i.a., FA 500 mg/m2 (2 h) day 1 i.v., and 5-FU 1.500 mg/m2 (24 h) day 1 i.a. Cycles have been repeated at days 15-22. The dose was adjusted according to the pretreatment performance status and elevation of alkaline phosphatase, bilirubin and serum albumin. Treatment was continued until progression or emergence of intolerable toxicity. Results: 11 patients received a total number of 43 TACE, with a range of 2-6 per patient. There was no TACE-related mortality. 4 patients died 5, 8, 10 and 11 months after initiation of treatment due to progression of disease. 7 patients are alive at 4+ (n = 2), 5+ (n = 1), 6+ (n = 1), 7+ (n = 1) and 11+ (n = 2) months after start of treatment. Toxicity (CTC) was mild with grade I-II asthenia (n = 10), grade I-II neurotoxicity (n = 5), grade II nausea and/or vomiting (n = 2) and grade II diarrhea (n = 1). Treatment had to be postponed due to grade I thrombocytopenia in 2 patients. No bleeding episodes or obvious infectious complications occurred during treatment intervals. 1 patient experienced an allergic reaction to oxaliplatin which led to exclusion from further therapy. Arterial catheter dislocation occurred in 3 patients. In 10 patients evaluable for response we observed 3 partial responses, 2 minor responses, and 4 times stable disease. Only 1 patient had further progression of disease under treatment. Conclusion: TACE, using a combination of mitomycin C, dexamethasone and interferon-α2b mixed with Spherex®, followed by oxaliplatin, FA and 5-FU, appears to be an effective and feasible treatment option in the case of liver metastasis of CRC refractory to standard systemic chemotherapy. This treatment is associated with tolerable toxicity, which becomes apparent mainly as asthenia, neurotoxicity or thrombocytopenia. These preliminary data warrant further evaluation for patients with refractory disease and would probably also be of interest for first-line treatment in this patient population.

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