Colon and rectal cancers unfortunately often
spread to the liver. However, it is well known
that these cancers may spread to the liver
and only the liver, without spread to other
sites. Chemotherapy agents such as Camptosar®
(CPT-11; irinotecan), 5-FU, and leucovorin
are used most commonly to treat this form
of cancer. These agents are commonly administered
into a vein (intravenously). An attractive
alternative is to administer chemotherapy
directly into the arteries that feed the liver.
The advantages of this approach are:
- A high rate (99%) of chemotherapy
drug extraction by the liver on first
passage of blood through the liver
leads to higher chemotherapy drug
concentrations in the tumors than
can be achieved with intravenous drug
administration.
- A high rate (99%) of chemotherapy
drug extraction by the liver on first
passage of blood through the liver
leads to lower levels of drug in tissues
outside the liver (e.g. bone marrow
and gut), which reduces side effects
of bone marrow suppression or nausea.
- Liver tumors are supplied principally
by the arteries in the liver, which
are the blood vessels into which the
active chemotherapy agent is administered.
- The likelihood of tumor shrinkage
is greater following intra-arterial
chemotherapy administration directly
into the liver compared to intravenous
adminisration.
- Patients whose tumors have increased
in size despite treatment with 5-FU
or Camptosar® (CPT-11; irinotecan)
still shrink in response to intraarterial
chemotherapy in roughly 50% of instances.
In an attempt to improve upon past results
with intra-arterial administration of
chemotherapy, we have initiated a clinical
trial that combines intra-arterial chemotherapy
with systemic (intravenous) chemotherapy
administration. FUDR (floxuridine) and
5-FU are administered intra-arterially,
while Camptosar® (CPT-11; irinotecan)
is adminstered intravenously. It is hoped
that this treatment will be more effective
than administration of any of these compounds
alone or together via an intravenous route.
Patients with colon or rectal cancer spread
to the liver that are eligible for this
clinical trial will have a small infusion
pump (roughly the size of a hockey puck)
inserted surgically into their abdomen
to administer the chemotherapy. Patients
that are not eligible for this trial may
still benefit from intra-arterial administration
of FUDR (without systemic administration
of Camptosar).
Kenneth K. Tanabe, MD
Associate Professor of Surgery, Harvard
Medical School
Chief, Division of Surgical Oncology,
Massachusetts General Hospital
Deputy Clinical Director, Massachusetts
General Hospital Cancer Center
James C. Cusack, MD
Assistant Professor of Surgery, Harvard
Medical School
Surgical Director, Tucker Gosnell Center
for Gastrointestinal Cancers
If you feel that you may be a candidate
for hepatic arterial infusion chemotherapy
for your liver tumor, please have your
physician contact:
Kenneth Tanabe, MD at 617-724-3868
James C. Cusack, MD at 617-724-4093
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