Intra-arterial hepatic chemotherapy in metastatic colorectal cancer: differences between oxaliplatin-naive versus oxaliplatin-pretreated patients

Background

Oxaliplatin-based hepatic arterial infusions (HAI) combined with intravenous therapy is a therapeutic option for colorectal cancer with liver-only metastasis, notably in the palliative setting, either initially or after failure of systemic chemotherapy. Our study aimed to assess efficacy and tolerance between oxaliplatin-naive patients and oxaliplatin-pretreated patients.

Methods

Between 2008 and 2022, single-center consecutive patients presenting with liver metastasis secondary to colorectal cancer who received at least one cycle of HAI-oxaliplatin combined with systemic therapy were included.

Results

The oxaliplatin-naive arm included 63 patients (median age 58 years) and the pretreated arm included 244 patients (median age 53 years). Patient characteristics were well balanced between the groups. All patients in the oxaliplatin-naive arm received HAI-oxaliplatin while 13% of the pretreated patients received HAI-FOLFIRINOX. After a median follow-up of 36 months, median progression-free survival was 14 months in the oxaliplatin-naive group (range 11.8-24 months) and 10.1 months in the pretreated group (range 9.4-12.5 months) (P = 0.016). The objective response rate was 66.7% and the disease control rate was 79.4% in the oxaliplatin-naive group, versus 32.4% and 77.5% (P < 0.001) in the pretreated group. Grade 3-4 toxicities were comparable between the two groups, including neuropathy. Secondary resection/ablation rate was 22.2% in oxaliplatin-naive patients and 17.6% in pretreated patients.

Conclusion

Oxaliplatin use as an intra-arterial hepatic infusion is feasible and efficient after previous systemic oxaliplatin; it showed significant response rates without increased toxicities. It can provide alternative treatments and spare late-setting drugs such as regorafenib and tipiracil–trifluridine for a further palliative intent treatment.