NEW YORK, NY, December 30, 1999 - A new treatment approach combining traditional chemotherapy with medication delivered through a surgically implanted pump has been found to increase life expectancy in patients with advanced colorectal cancer that has spread to the liver, reports Nancy Kemeny, M.D., an oncologist at Memorial Sloan-Kettering Cancer Center.
The study, published in the December 30 issue of the New England Journal of Medicine, evaluated 156 patients with colorectal cancer who had undergone surgery to remove tumors that had spread to the liver. In the study, one group of colorectal cancer patients treated with standard systemic chemotherapy - drugs that circulate throughout the body - was compared to a second group treated with a combination of systemic chemotherapy and hepatic arterial infusion therapy. This type of therapy delivers drugs directly into the arteries that feed the liver via a surgically implanted pump placed in the abdomen. The Memorial Sloan-Kettering researchers found that the combined treatment significantly increased two-year survival rates and decreased the recurrence of tumors that had spread to the liver in patients with metastatic colorectal cancer.
"Our results show that combining these two treatment approaches provides a more effective way to treat colorectal cancer patients who have had surgery to remove tumors that have spread to the liver. Not only did these patients live longer than those treated with traditional systemic chemotherapy, but they had significantly less recurrence of disease in the liver," said Dr. Kemeny.
Previous research had shown that surgery to remove tumors from the liver offered the best chance of cure for those patients whose colon cancer had spread to the liver, but only 25 percent of patients would remain free of a recurrence of disease.
To increase survival and decrease recurrence, the investigators added the drug floxuridine (FUDR) and dexamethasone (DEX) via continuous hepatic infusion to the systemic chemotherapy drug regimen of 5-flurorouracil (5-FU) and leucovorin and compared this treatment to systemic therapy alone. Since FUDR is readily absorbed in the liver, high doses can be given via a pump with no systemic side effects.
The researchers found that 86 percent of patients receiving the combined therapies survived longer than two years compared to 72 percent of patients receiving only systemic chemotherapy. Moreover, 90 percent of the colorectal patients who were treated with the combined therapies had no recurrence of tumors in the liver, while 60 percent of patients treated with systemic chemotherapy had no recurrence in the liver at two years.
"These results are impressive as this is the first study to show an increase in survival with treatment after surgery to remove metastasis in the liver," said Dr. Kemeny.
The investigators plan to conduct future clinical trials combining different systemic drug regimens combined with therapy administered via the implantable pump technology.
Memorial Sloan-Kettering Cancer Center is the world's oldest and largest private institution devoted to prevention, patient care, research, and education in cancer. Throughout its long distinguished history, the Center has played a leadership role in defining the standard of care for patients with cancer. In 1999, Memorial Sloan-Kettering was named the nation's best cancer care center for the seventh consecutive year by U.S. News & World Report.
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Journal
New England Journal of Medicine