Intra-arterial chemotherapy in metastatic colorectal cancer: a review of the literature and a clinical case
Cherchenko K., Lukashenko A. , Ostapenko Y. , Patsko V. , Vinohradova M., Valikhnovska K. , Pamanska S.
Summary. Aim. To analyte the studies of the effectiveness of intra-arterial administration of cytotoxic and targeted drugs in colorectal cancer metastases in the liver; to compare them with traditional chemotherapy and other systemic therapy options; to evaluate the perspectivity of the method in conversion of inoperable metastases into operable ones; to assess the impact of intra-arterial chemotherapy on survival rates. Materials and methods. The publications from NCBI, PubMed, ESMO, ASCOPubs were used, searched via keywords «HAI», «liver metastases of colorectal cancer», «metastatic colorectal cancer», «regional chemotherapy», «intra-arterial chemotherapy». For the presentation of clinical case, archive materials of the department of minimally invasive and endoscopic surgery, interventional radiology of the National Cancer Institute were used. Results. Due to the high selectivity of patients who can be offered this approach and the technical complexity of its implementation, the data of the literature are presented mostly by I–II phases clinical trials. Schemes using intra-arterial fluoropyrimidines and oxaliplatin (separately or in combination) have shown positive results in progression-free survival, overall survival and conversion rate from unresectable liver metastases to resectable. Intra-arterial irinotecan has not proven superior to intravenous irinotecan. Intra-arterial administration of bevacizumab within the data of existing studies has not demonstrated advantages in regional administration, and also has mixed safety data: according to some studies, it increases the risk of side effects (when combined with intra-arterial fluoropyrimidines), and according to others, it does not affect their frequency (when combined with intra-arterial oxaliplatin), so the possibility and expediency of using this drug in liver infusion is ambiguous. The publication also provides a positive experience of using the technique at the National Cancer Institute. A patient with inoperable liver metastases from colorectal cancer underwent four full cycles and one incomplete of intra-arterial FOLFOX chemotherapy. After re-evaluation, metastases have reached a resectable state, so liver resection was performed. According to the results of histology, a complete response was obtained. Conclusions. Intra-arterial chemotherapy of liver metastases of colorectal cancer is a non-standard technique that cannot be performed on all patients, but with the right evaluation of indications and the absence of contraindications, it can become a life-saving option for patients who have exhausted the recommended lines of therapy or who are resistant to systemic chemotherapy. Further development with the involvement of new drugs and combinations of previously known ones has clinical significance for oncologists of Ukraine and the world.
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