Annual Meeting Proceedings Part 1 - American Society of Clinical ...

222s Gastrointestinal (Colorectal) Cancer
3577 General Poster Session (Board #31F), Mon, 8:00 AM-12:00 PM
Is conversion to resection possible with hepatic arterial infusion (HAI) and
systemic (SYS) even in previously treated patients (pts) with unresectable
colorectal liver metastases (UnCLM)? Presenting Author: Nancy E. Kemeny,
Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Previously, we showed thatHAI with FUDR � dexamethasone
(Dex) plus SYS produced a 47 % resectability rate in a retrospective study
of 49 pts with UnCLM. Methods: Prospectively evaluated UnCLM pts in a
new protocol were combined with the above protocol (n�105 pts) and all
were treated with HAI FUDR/Dex � Sys. Unresectability was defined as
diffuse bilateral metastases, involvement of all hepatic/portal veins, and/or
inability to preserve remaining liver with adequate perfusion. Factors
associated with conversion were identified using a multivariate logistic
regression model. Overall survival (OS) and progression free survival (PFS)
were calculated from pump placement by the Kaplan-Meier method.
Resectability was a time-dependent covariate in a Cox regression model.
Results: 61 of the 105 pts had prior SYS (56 %with prior Oxali) and 45
(74%) were progressing at the time of pump placement. In previously
treated pts, 44% underwent resection, with a median OS of 45 mos. Of 44
chemo-naïve pts, 57% underwent hepatectomy, with a median OS of 68
mos. The following were significantly associated with resection conversion:
lesion number [p�0.02], baseline CEA [p�0.04], females [p�0.03] and
clinical risk score (CRS) [p�0.05]. In multivariate analysis, gender and
CRS remained predictive of resectability. Surgery greatly reduced the
hazard of death by 67% [HR: 0.33, 95%CI: 0.17-0.61, p�0.0004], after
adjusting for several risk factors (Table). Median PFS was 12 mos for all
pts. Conclusions: Even in previously treated pts,HAI � SYS is an approach
to convert UnCLM to resection. Gender and CRS are associated with
conversion to resectability.
Multivariate Cox regression models.
HR (95%CI) P value
OS
Surgery (yes vs no)* 0.33 (0.17-0.61) �0.001
Gender (F vs M) 0.95 (0.51-1.77) 0.88
CRS (>3vs3vs