Phase I trial of adjuvant hepatic arterial infusion (HAI) with floxuridine (FUDR) and dexamethasone plus systemic oxaliplatin, 5-fluorouracil and leucovorin in patients with resected liver metastases from colorectal cancer

Abstract

Background: The purpose of the study was to determine the maximum tolerated dose of systemic oxaliplatin (oxal), 5-fluorouracil (5-FU) and leucovorin (LV) that could be administered with hepatic arterial infusion (HAI) of floxuridine (FUDR) and dexamethasone (Dex) in the adjuvant setting after hepatic resection.

Methods: Thirty-five patients with resected liver metastases were entered into a phase I trial using HAI FUDR/Dex with escalating doses of oxal and 5-FU.

Results: The initial dose of HAI FUDR was fixed at 0.12 mg/kg x pump volume divided by pump flow rate plus Dex infused over the first 2 weeks of a 5-week cycle. Systemic chemotherapy was delivered on days 15 and 29 with the doses of oxal escalated from 85 to 100 mg/m2 and the 5-FU 48-h continuous infusion doses from 1000 to 2000 mg/m2. The LV dose was fixed at 400 mg/m). Dose-limiting toxic effects were diarrhea, 8.5%, and elevated bilirubin, 8.5%. With a median follow-up of 43 months, the 4-year survival and progression-free survival were 88% and 50%, respectively.

Conclusions: Adjuvant therapy after liver resection with HAI FUDR/Dex plus systemic oxal at 85 mg/m2 and 5-FU by continuous infusion at 2000 g/m2 with LV at 400 mg/m2 is feasible and appears effective. Randomized studies comparing this regimen to systemic FOLFOX are suggested.

Figures

Figure 1

Overall survival from the time of liver resection for the patients treated with adjuvant HAI FUDR/Dex plus systemic oxaliplatin/5-FU/LV. HAI, hepatic arterial infusion; FUDR, floxuridine; Dex, dexamethasone; 5-FU, 5-fluorouracil; LV, leucovorin.

Figure 2

Progression-free survival from the time of liver resection for the patients treated with adjuvant HAI FUDR/Dex plus systemic oxaliplatin/5-FU/LV. HAI, hepatic arterial infusion; FUDR, floxuridine; Dex, dexamethasone; 5-FU, 5-fluorouracil; LV, leucovorin.

Figure 3

Time to hepatic progression from the time of liver resection for the patients treated with adjuvant HAI FUDR/Dex plus systemic oxaliplatin/5-FU/LV. HAI, hepatic arterial infusion; FUDR, floxuridine; Dex, dexamethasone; 5-FU, 5-fluorouracil; LV, leucovorin.