Alternating Floxuridine and 5-fluorouracil Hepatic Arterial Chemotherapy for Colorectal Liver Metastases Minimizes Biliary Toxicity

Am J Surg. 1996 Sep;172(3):244-7. doi: 10.1016/s0002-9610(96)00159-6.

Abstract

Background: The goals of this study of a hepatic arterial infusion (HAI) regimen of alternating floxuridine and 5-fluorouracil were to evaluate the treatment-related toxic effects, the antitumor response rate, and patient survival.

Methods: Fifty-seven consecutive patients were treated with implanted HAI pumps and received a regimen of alternating floxuridine (0.1 mg/kg/day continuous HAI for 7 days) followed by a weekly HAI pump bolus of 5-fluorouracil (15 mg/kg for 3 weeks). Any changes in treatment plan because of toxicity, antitumor response, and survival were recorded.

Results: Thirty-one (54.4%) patients responded to this HAI regimen; 14 (24.5% )patients had stable disease, and 12 (21.1%) progressed during treatment. Responders or patients with stable disease had a significantly (P < 0.05) improved survival rate (19 months median) compared with patients in whom disease progressed (12 months median). Two (3.5%) patients developed biliary sclerosis and 12 (21.1%) had mild transient liver function abnormalities. The liver alone or in combination with another area was the site of first progression of disease in 40 (70.2%) patients.

Conclusions: This regimen had reversible or no hepatobiliary toxicity in more than 95% of patients. Tumor reduction or stabilization of disease was observed in 79% of the patients, who had a median survival of 19 months. Reduced toxicity and more effective chemotherapeutic regimens may increase the likelihood of survival after HAI chemotherapy for unresectable colorectal liver metastases.

MeSH terms

  • Adult
  • Aged
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biliary Tract Diseases / chemically induced*
  • Colorectal Neoplasms / pathology*
  • Female
  • Floxuridine / administration & dosage
  • Floxuridine / adverse effects
  • Fluorouracil / administration & dosage
  • Fluorouracil / adverse effects
  • Humans
  • Infusion Pumps, Implantable
  • Infusions, Intra-Arterial*
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / secondary*
  • Male
  • Middle Aged
  • Retrospective Studies

Substances

  • Antimetabolites, Antineoplastic
  • Floxuridine
  • Fluorouracil