Alternating systemic and hepatic artery infusion therapy for resected liver metastases from colorectal cancer

A North Central Cancer Treatment Group (NCCTG)/ National Surgical Adjuvant Breast and Bowel Project (NSABP) phase II intergroup trial, N9945/CI-66

Steven Robert Alberts, Mark S. Roh, Michelle R. Mahoney, Michael J. O'Connell, David M. Nagorney, Lawrence Wagman, Thomas Christopher Smyrk, Timothy L. Weiland, Lily Lau Lai, Roderich E. Schwarz, Roy Molina, Todor Dentchev, John S. Bolton

Research output: Contribution to journalArticle

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Abstract

Purpose: Prior trials have shown that surgery followed by hepatic artery infusion (HAI) of floxuridine (FUDR) alternating with systemic fluorouracil improves survival rates. Oxaliplatin combined with capecitabine has demonstrated activity in advanced colorectal cancer. Based on this observation a trial was conducted to assess the potential benefit of systemic oxaliplatin and capecitabine alternating with HAI of FUDR. The primary end point was 2-year survival. Patients and Methods: Patients with liver-only metastases from colorectal cancer amenable to resection or cryoablation were eligible. HAI and systemic therapy was initiated after metastasectomy. Alternating courses of HAI consisted of 0.2 mg/m2/d FUDR and dexamethasone, day 1 through 14 weeks 1 and 2. Systemic therapy included oxaliplatin 130 mg/m2 day 1 with capecitabine at 1,000 mg/m2 twice daily, days 1 through 14, weeks 4 and 5. Two additional 3-week courses of systemic therapy were given. Capecitabine was reduced to 850 mg/m2 twice daily after interim review of toxicity. Results: Fifty-five of 76 eligible patients were able to initiate protocol-directed therapy and completed median of six cycles (range, one to six). Three postoperative or treatment-related deaths were reported. Overall, 88% of evaluable patients were alive at 2 years. With a median follow-up of 4.8 years, a total of 30 patients have had disease recurrence, 11 involving the liver. Median disease-free survival was 32.7 months. Conclusion: Alternating HAI of FUDR and systemic capecitabine and oxaliplatin met the prespecified end point of higher than 85% survival at 2 years and was clinically tolerable. However, the merits of this approach need to be established with a phase III trial.

Original languageEnglish (US)
Pages (from-to)853-858
Number of pages6
JournalJournal of Clinical Oncology
Volume28
Issue number5
DOIs
StatePublished - Feb 10 2010

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oxaliplatin
Hepatic Artery
Colorectal Neoplasms
Breast
Neoplasm Metastasis
Liver
Neoplasms
Metastasectomy
Floxuridine
Therapeutics
Cryosurgery
Survival
Fluorouracil
Dexamethasone
Disease-Free Survival
Survival Rate
Capecitabine
Recurrence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Alternating systemic and hepatic artery infusion therapy for resected liver metastases from colorectal cancer : A North Central Cancer Treatment Group (NCCTG)/ National Surgical Adjuvant Breast and Bowel Project (NSABP) phase II intergroup trial, N9945/CI-66. / Alberts, Steven Robert; Roh, Mark S.; Mahoney, Michelle R.; O'Connell, Michael J.; Nagorney, David M.; Wagman, Lawrence; Smyrk, Thomas Christopher; Weiland, Timothy L.; Lai, Lily Lau; Schwarz, Roderich E.; Molina, Roy; Dentchev, Todor; Bolton, John S.

In: Journal of Clinical Oncology, Vol. 28, No. 5, 10.02.2010, p. 853-858.

Research output: Contribution to journalArticle

Alberts, Steven Robert ; Roh, Mark S. ; Mahoney, Michelle R. ; O'Connell, Michael J. ; Nagorney, David M. ; Wagman, Lawrence ; Smyrk, Thomas Christopher ; Weiland, Timothy L. ; Lai, Lily Lau ; Schwarz, Roderich E. ; Molina, Roy ; Dentchev, Todor ; Bolton, John S. / Alternating systemic and hepatic artery infusion therapy for resected liver metastases from colorectal cancer : A North Central Cancer Treatment Group (NCCTG)/ National Surgical Adjuvant Breast and Bowel Project (NSABP) phase II intergroup trial, N9945/CI-66. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 5. pp. 853-858.
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abstract = "Purpose: Prior trials have shown that surgery followed by hepatic artery infusion (HAI) of floxuridine (FUDR) alternating with systemic fluorouracil improves survival rates. Oxaliplatin combined with capecitabine has demonstrated activity in advanced colorectal cancer. Based on this observation a trial was conducted to assess the potential benefit of systemic oxaliplatin and capecitabine alternating with HAI of FUDR. The primary end point was 2-year survival. Patients and Methods: Patients with liver-only metastases from colorectal cancer amenable to resection or cryoablation were eligible. HAI and systemic therapy was initiated after metastasectomy. Alternating courses of HAI consisted of 0.2 mg/m2/d FUDR and dexamethasone, day 1 through 14 weeks 1 and 2. Systemic therapy included oxaliplatin 130 mg/m2 day 1 with capecitabine at 1,000 mg/m2 twice daily, days 1 through 14, weeks 4 and 5. Two additional 3-week courses of systemic therapy were given. Capecitabine was reduced to 850 mg/m2 twice daily after interim review of toxicity. Results: Fifty-five of 76 eligible patients were able to initiate protocol-directed therapy and completed median of six cycles (range, one to six). Three postoperative or treatment-related deaths were reported. Overall, 88{\%} of evaluable patients were alive at 2 years. With a median follow-up of 4.8 years, a total of 30 patients have had disease recurrence, 11 involving the liver. Median disease-free survival was 32.7 months. Conclusion: Alternating HAI of FUDR and systemic capecitabine and oxaliplatin met the prespecified end point of higher than 85{\%} survival at 2 years and was clinically tolerable. However, the merits of this approach need to be established with a phase III trial.",
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T1 - Alternating systemic and hepatic artery infusion therapy for resected liver metastases from colorectal cancer

T2 - A North Central Cancer Treatment Group (NCCTG)/ National Surgical Adjuvant Breast and Bowel Project (NSABP) phase II intergroup trial, N9945/CI-66

AU - Alberts, Steven Robert

AU - Roh, Mark S.

AU - Mahoney, Michelle R.

AU - O'Connell, Michael J.

AU - Nagorney, David M.

AU - Wagman, Lawrence

AU - Smyrk, Thomas Christopher

AU - Weiland, Timothy L.

AU - Lai, Lily Lau

AU - Schwarz, Roderich E.

AU - Molina, Roy

AU - Dentchev, Todor

AU - Bolton, John S.

PY - 2010/2/10

Y1 - 2010/2/10

N2 - Purpose: Prior trials have shown that surgery followed by hepatic artery infusion (HAI) of floxuridine (FUDR) alternating with systemic fluorouracil improves survival rates. Oxaliplatin combined with capecitabine has demonstrated activity in advanced colorectal cancer. Based on this observation a trial was conducted to assess the potential benefit of systemic oxaliplatin and capecitabine alternating with HAI of FUDR. The primary end point was 2-year survival. Patients and Methods: Patients with liver-only metastases from colorectal cancer amenable to resection or cryoablation were eligible. HAI and systemic therapy was initiated after metastasectomy. Alternating courses of HAI consisted of 0.2 mg/m2/d FUDR and dexamethasone, day 1 through 14 weeks 1 and 2. Systemic therapy included oxaliplatin 130 mg/m2 day 1 with capecitabine at 1,000 mg/m2 twice daily, days 1 through 14, weeks 4 and 5. Two additional 3-week courses of systemic therapy were given. Capecitabine was reduced to 850 mg/m2 twice daily after interim review of toxicity. Results: Fifty-five of 76 eligible patients were able to initiate protocol-directed therapy and completed median of six cycles (range, one to six). Three postoperative or treatment-related deaths were reported. Overall, 88% of evaluable patients were alive at 2 years. With a median follow-up of 4.8 years, a total of 30 patients have had disease recurrence, 11 involving the liver. Median disease-free survival was 32.7 months. Conclusion: Alternating HAI of FUDR and systemic capecitabine and oxaliplatin met the prespecified end point of higher than 85% survival at 2 years and was clinically tolerable. However, the merits of this approach need to be established with a phase III trial.

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