A bullish assessment:
In Marshall’s lecture, “Where Are We With Liver- Directed Therapy in Metastatic CRC?” he plans to review the history and current evidence for the use of liver-directed therapies in mCRC, as well as the need to partner with interventional radiology teams as part of a multidisciplinary approach to treating patients.
For example, during the 2016 World Congress on GI Cancer, researchers showed that selective internal radiation therapy with SIR-Spheres Y-90 resin microspheres added to standard frontline chemotherapy led to a significant increase in hepatic depth of response in patients with mCRC, according to an analysis of the phase III SIRFLOX study.
“There has been a great deal of innovation in terms of liver-specific management for metastatic colon cancer,” said Marshall. “We have gone from when we were simply embolizing tumors to now delivering smarter technologies, the most recent of which is radioembolization where injections of radioactive materials are given.” Not only is the treatment safe and well tolerated, but there are early signs of significant clinical improvement, he said.
Marshall speculated that over the next couple of years, additional data may be reported supporting the use of liver-directed therapy in early lines of therapy as opposed to salvage treatment.
http://www.targetedonc.com/news/future-looks-bright-for-gi-cancers-experts-agree
I spoke to Marshall back in April and he said that the liver PFS data from SIRFLOX had encouraged him to start using SIRT in selected 1st and 2nd line patients (use as a bridging treatment between 1st and 2nd line chemo, use on patients with a high liver tumor burden etc). He said that the main concern with using it early is that they need more data on long-term toxicity as patients are living longer with CRC and thus you need to know how the radioembolization will be impacting the patient's liver 3-5 years down the track. He said they should get comfort around this when the full OS data comes out.
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