Hepatic Arterial Infusion Chemotherapy in Patients With Inoperable Colorectal Cancer Liver Metastasis

Inclusion criteria

• History of histologically confirmed colorectal adenocarcinoma metastatic to the liver with no clinical or radiographic evidence of extrahepatic disease. Patients with resectable or ablatable lung metastasis are eligible.
• Physically able to tolerate major partial hepatectomy.
• The primary tumor may be in place at the time of registration if not obstructing the intestinal lumen or significantly bleeding. If present, the primary tumor will be resected at the time of pump placement.
• Chest, Abdominal and Pelvic CT scan with CT angiogram within 6 weeks prior to registration. (MRI angiogram with contrast of the abdomen may be substituted for CT of the abdomen).
• The patient must have inoperable liver metastases as agreed upon by any two hepatobiliary surgeons and the assigned radiologist. In the event that two hepatobiliary surgeons cannot agree, a third surgeon will be consulted. Continued discrepancy will result in the patient's case being presented at weekly hepatobiliary conference for consensus opinion. Inoperable metastases are defined as: requiring a resection that leaves less than 2 hepatic segments (not including the caudate lobe) behind with adequate arterial/portal inflow, venous outflow and biliary drainage. \* A patient is considered resectable if the procedure includes a minor wedge or thermo-ablation encompassing 10% or less of the volume of the remaining 2 segments.
• Patient's liver metastases must comprise \<70% of the liver parenchyma.
• Female patients of child-bearing age must undergo a pregnancy test and have a negative result.
• A patient must have had prior chemotherapy.
• ECOG PS \< 2.
• Within 14 days of registration: o WBC \>3X10E9/L; ANC ≥ 1.5X10E9/L; Platelet count \>100X10E9/L; INR \< 1.5; HGB ≥ 90 g/L; Estimated creatinine clearance ≥30 ml/min (using Cockcroft and Gault formula); Total serum bilirubin \<25.6 umol/L.
• Age ≥ 18 years.
• Signed informed consent.
• Subject's willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures.
• Patients with limited/responding lung metastases on Physician's discretion.

Exclusion criteria

• Prior radiation to the liver (prior radiation therapy to the pelvis is acceptable if completed at least 4 weeks prior to registration).
• Patient may not have received prior treatment with FUDR.
• Active infection, ascites, hepatic encephalopathy.
• Active concurrent malignancies, except a patient's potentially resectable colorectal primary.
• Extrahepatic metastases except for resectable or ablatable lung metastasis.
• Patient must not have obstruction of GI or GU tract.
• Female patients who are pregnant or lactating.
• Patients may not be receiving any other investigational agents.
• Patients with history of primary CNS tumors, seizures not well-controlled with standard medical therapy, or history of stroke will also be excluded (history of stroke or transient ischemic attack within 6 months prior to Day 1).
• Serious or non-healing active wound, ulcer, or bone fracture.
• Chronic daily treatment with aspirin (\> 325 mg/d) or nonsteroidal anti- inflammatory medications known to inhibit the platelet function.
• Presence of bleeding diathesis or coagulopathy.
• History of serious systemic disease, including myocardial infarction within the last 6 months, uncontrolled hypertension (blood pressure of \> 150/100 mmHg on medication), unstable angina, New York Heart Association (NYHA) Grade II or greater congestive heart failure, unstable symptomatic arrhythmia requiring medication (subjects with chronic atrial arrhythmia, i.e. atrial fibrillation or paroxysmal supraventricular tachycardia are eligible), or peripheral vascular disease (Grade II or greater).