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Phase II trial of multiagent chemotherapy combined with Y-90 microsphere selective internal radiation therapy (chemo-SIRT) in patients with colorectal cancer liver metastases.
Sub-category: Colorectal Cancer (including liver metastases)
Category: Gastrointestinal (Colorectal) Cancer
Meeting: 2008 ASCO Annual Meeting




Abstract No: 15011
Citation: J Clin Oncol 26: 2008 (May 20 suppl; abstr 15011)
Author(s): K. L. Pennington, S. A. Gulec, D. Breutman, R. Hostetter, J. Wheeler, D. Schwartzentruber
Abstract: Background: Concurrent chemotherapy and radiation in colorectal cancer(CRC) can improve outcome of local or regional disease. This study is an attempt to derive a similar benefit using chemotherapy and a novel method of radiation therapy for patients with CRC metastatic to liver. Yttrium-90 (Y-90) microsphere selective internal radiation treament (SIRT) has proven to be a safe and effective mode of radiation delivery technique in patients (pts) with CRCLM as a single modality and with 5-FU and FUDR. This is a phase II trial of Y-90 microspheres and concurrent multiagent chemotherapy for management of CRCLM. This study is designed to measure response using updated methods of measurements based on pet scan and computer modeling as well as common criteria. Assessment of toxicity, especially hepatotoxicity and myelotoxicity, is the second major objective. Methods: 20 patients with disease limited predominantly to the liver were recruited for the study. Pre-treatment studies included a liver-protocol PET-CT, angiogram and 99mTc-MAAA (macroaggregaated albumin) imaging. Chemotherapy (Fol-Fox or Fol-Firi) was planned every 2 weeks for 8 cycles. SIRT with Y-90 resin microspheres (Sirtex Medical, Wilmington, MA) was administered on day 2 of the first chemotherapy course either lobar or whole-liver fashion. Administered activity of Y-90 microspheres ranged from 0.2 to 3.8 GBq (mean 1.8 GBq). CEA levels, tumor anatomic volume (VA) and functional volume (VF) by FDG-PET/CT were used to determine tumor response. Results: 20 patients have been treated and 19 are evaluable. 13 patients were chemo-naive, 7 had prior chemo. 3 received whole liver, 16 received lobar, one segmental SIRT. 16/19 patients had a VF decrease of >90% and the average decrease for 3 was 56%. 15/16 pts with an elevated cea had >50% decline. 12/19 pts had > 50% reduction in VA. 4 patients have undergone surgery subsequent to chemo-SIRT. 4 pts required hospitalization due to SAE, 1 with neutropenic fever. 2 pts had grade 3 sphere-induced gi ulcer. Conclusions: Chemo-SIRT with modern chemotherapy results in a high objective response rate with acceptable toxicity and deserves further study.


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Other Abstracts in this Sub-Category
1. KRAS status and efficacy in the first-line treatment of patients with metastatic colorectal cancer (mCRC) treated with FOLFIRI with or without cetuximab: The CRYSTAL experience.
Meeting: 2008 ASCO Annual Meeting Abstract No: 2 First Author: E. Van Cutsem
Category: Gastrointestinal (Colorectal) Cancer - Colorectal Cancer (including liver metastases)
2. KRAS status and efficacy of first-line treatment of patients with metastatic colorectal cancer (mCRC) with FOLFOX with or without cetuximab: The OPUS experience.
Meeting: 2008 ASCO Annual Meeting Abstract No: 4000 First Author: C. Bokemeyer
Category: Gastrointestinal (Colorectal) Cancer - Colorectal Cancer (including liver metastases)
3. Relationship of efficacy with KRAS status (wild type versus mutant) in patients with irinotecan-refractory metastatic colorectal cancer (mCRC), treated with irinotecan (q2w) and escalating doses of cetuximab (q1w): The EVEREST experience (preliminary data).
Meeting: 2008 ASCO Annual Meeting Abstract No: 4001 First Author: S. Tejpar
Category: Gastrointestinal (Colorectal) Cancer - Colorectal Cancer (including liver metastases)
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