University of Pennsylvania Cancer Center
Last Modified: May 16, 1999
Approximately 138,000 new cases of colorectal cancer are diagnosed in the US every year. Eventually, 60% of these patients will develop liver metastasis but only a small percentage of these patients respond to systemic chemotherapy, a common treatment. Now, researches at Memorial Sloan-Kettering Cancer Center have found that a novel combination fo three different treatments appears to provide the best chance for disease-free survival for these patients.
The investigators, led by Dr. Nancy Kemeny, designed a trial that paired surgery with one or two different methods of delivering chemotherapy. The study randomized 156 patients who had undergone liver surgery to receive either systemic chemotherapy or systemic chemotherapy plus localized chemotherapy directly injected into the hepatic artery, which feeds liver metastases.
The results showed significant benefit to giving patients localized as well as systemic chemotherapy. Two years after treatment, 85 percent of patients who had hepatic as well as systemic infusion had survived and 89 percent of them had no liver lesions. Comparatively, 69 percent of patients treated with systemic chemotherapy had survived and 57 percent of them had no liver cancer.
The two arms of the study were matched for multiple factors, including number of liver metastases, size of tumor, Dukes stage C, size of hepatic margins, and TS levels. The toxicity profile for this modality was comparable in severity of mouth lesions, but with the study arm, there was more diarrhea , and liver function abnormalities. This study was also unique in that enrollment was not limited by the amount of liver metastases, whereas generally studies limit patients to less than 4 metastases. There were 2 other studies presented at this year's ASCO meeting on arterial infusion of chemotherapy. Dr. Kemeny reports that there are in excess of ten other institutions which have adopted this therapeutic approach. She envisions that in the future, this modality will be combined with other approaches which will allow for decreasing the toxicity of this therapy. She ended her talk with the following statement: "On a personal note, I have been taking care of colon cancer patients since 1974, and in the past, most didn't survive -- this is very exciting."