The liver is the most frequent site for metastases of colorectal cancer. It is the second largest contributor to cancer deaths in Europe.
In this study, researchers from England and Scotland performed a randomized trial to compare 2 treatment regimens in patients with colorectal cancer, and metastases confined to the liver. They compared an intrahepatic arterial (IHA) fluorouracil and folinic acid regimen, with the standard intravenous de Gramont fluorouracil and folinic acid regimen.
The research team randomly allocated 290 patients from 16 centers to receive either intravenous chemotherapy, or IHA chemotherapy designed to be equitoxic.
|No significant difference in progression-free survival.|
The primary endpoint was overall survival, and analysis was by intention to treat.
However, 37% of patients allocated to IHA did not start their treatment, and a further 29% discontinued treatment before receiving 6 cycles, due to catheter failure. Of these, 45 patients switched to intravenous treatment.
The team found that the IHA group received a median of 2 cycles, compared with 8.5 for the intravenous group.
In both groups, grade 3 or 4 toxicity was uncommon.
The researchers determined that median overall survival was 14.7 months for the IHA group and 14.8 months for the intravenous group (hazard ratio 1.04).
Similarly, there was no significant difference in progression-free survival.
Prof. David Kerr’s team concluded, “Our results showed no evidence of an advantage in progression-free survival or overall survival for the IHA group”.
“Thus continued use of this regimen cannot be recommended outside of a clinical trial.”