Alternating floxuridine and 5-fluorouracil hepatic arterial chemotherapy for colorectal liver metastases minimizes biliary toxicity

• Published in: The American journal of surgery 1996-09, Vol.172 (3), p.244-247
• Main Authors: Scott Davidson, B., Izzo, Francesco, Chase, Judy L, DuBrow, Ronelle A., Patt, Yehuda, Hohn, David C., Curley, Steven A.
• Format: Article
• Language: English
• Subjects: 5-Fluorouracil; Abnormalities; Adult; Aged; Anticancer properties; Antimetabolites, Antineoplastic - administration & dosage; Antimetabolites, Antineoplastic - adverse effects; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antitumor activity; Biliary Tract Diseases - chemically induced; Biological and medical sciences; Chemotherapy; Colorectal Neoplasms - pathology; Female; Floxuridine - administration & dosage; Floxuridine - adverse effects; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Humans; Infusion Pumps, Implantable; Infusions, Intra-Arterial; Liver; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Male; Medical sciences; Metastases; Middle Aged; Pharmacology. Drug treatments; Retrospective Studies; Sclerosis; Survival; Toxicity
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(96)00159-6

The goals of this study of a hepatic arterial infusion (HAI) regimen of alternating floxuridine and 5-fluorouracil were to evaluate the treatment-related toxic effects, the antitumor response rate, and patient survival. Fifty-seven consecutive patients were treated with implanted HAI pumps and received a regimen of alternating floxuridine (0.1 mg/kg/day continuous HAI for 7 days) followed by a weekly HAI pump bolus of 5-fluorouracil (15 mg/kg for 3 weeks). Any changes in treatment plan because of toxicity, antitumor response, and survival were recorded. Thirty-one (54.4%) patients responded to this HAI regimen; 14 (24.5%) patients had stable disease, and 12 (21.1%) progressed during treatment. Responders or patients with stable disease had a significantly ( P < 0.05) improved survival rate (19 months median) compared with patients in whom disease progressed (12 months median). Two (3.5%) patients developed biliary sclerosis and 12 (21.1%) had mild transient liver function abnormalities. The liver alone or in combination with another area was the site of first progression of disease in 40 (70.2%) patients. This regimen had reversible or no hepatobiliary toxicity in more than 95% of patients. Tumor reduction or stabilization of disease was observed in 79% of the patients, who had a median survival of 19 months. Reduced toxicity and more effective chemotherapeutic regimens may increase the likelihood of survival after HAI chemotherapy for unresectable colorectal liver métastases.