Bhutiani Neal, Akinwande Olaguoke, Martin Robert C G
Division of Surgical Oncology, Upper Gastrointestinal and Hepato-Pancreatico-Biliary Clinic, 315 E. Broadway - #311, Louisville, KY, 40202, USA.
World J Surg. 2016 May;40(5):1178-90. doi: 10.1007/s00268-015-3386-9.
Response rates to systemic chemotherapy for patients who have failed irinotecan-based chemotherapy for liver-dominant metastatic colorectal cancer range between 10 and 18 % with overall survival between 7 and 9 months. The aim of this study was to assess the efficacy and safety of hepatic arterial irinotecan therapy in patients with hepatic-dominant metastatic colorectal cancer who had failed systemic irinotecan.
This was a multi-institutional, multi-national, analysis of patients who received DEBIRI in the setting of unresectable liver-dominant metastatic colorectal cancer. Patients had received between 1 and 4 lines of prior chemotherapy, the majority of which included systemic irinotecan. Primary endpoints were toxicity profile and tumor response rate.
296 patients with unresectable liver metastases who had undergone 666 DEBIRI treatments were reviewed. 192 treatments were performed in patients who had received prior systemic irinotecan. 222 treatments were performed in irinotecan-naïve patients. The median number of DEBIRI treatments was 1 (range 1-8); median treatment dose was 100 mg (range 50-200 mg), with total hepatic treatment of approximately 100 mg (range 20/30-200/300 mg). All-grade adverse events occurred in 18 % of patients receiving prior systemic irinotecan compared with 15 % of patients receiving no prior systemic irinotecan (including chemo-naïve patients). Response rates in patients with prior systemic irinotecan were 44 % at 3 months, 43 % at 6 months, and 44 % at 12 months, compared with 45, 40, and 35 % during the same time point in patients without prior systemic irinotecan. All-grade adverse events occurred in 10, 20, 10, and 37 % of patients receiving 0, 1, 2, and 3+ lines of systemic chemotherapy, respectively. Overall survival was 90 %, 93 %, 90 %, 90 % at 6 months and 76 %, 71 %, 77 %, 87 % at 12 months in patients undergoing DEBIRI therapy after receiving 0, 1, 2, and 3+ lines of systemic chemotherapy, respectively.
The safety and efficacy of hepatic arterial drug-eluting irinotecan bead (DEBIRI) therapy are not affected by non-response to prior systemic irinotecan. While DEBIRI complete response rates are greatest and overall adverse events are least in chemotherapy-naïve individuals, it retains its respectable efficacy and low rate of serious adverse events even in the setting of previous administration of systemic chemotherapy.
对于以伊立替康为基础的化疗失败的肝转移为主的转移性结直肠癌患者，全身化疗的缓解率在10%至18%之间，总生存期在7至9个月之间。本研究的目的是评估肝动脉伊立替康治疗对全身伊立替康治疗失败的肝转移为主的转移性结直肠癌患者的疗效和安全性。
这是一项多机构、跨国的分析，研究对象为在不可切除的肝转移为主的转移性结直肠癌患者中接受载药微球肝动脉栓塞化疗（DEBIRI）的患者。患者之前接受过1至4线化疗，其中大部分包括全身伊立替康治疗。主要终点是毒性特征和肿瘤缓解率。
回顾了296例有不可切除肝转移且接受过666次DEBIRI治疗的患者。192次治疗是在接受过全身伊立替康治疗的患者中进行的。222次治疗是在未接受过伊立替康治疗的患者中进行的。DEBIRI治疗的中位数为1次（范围1至8次）；中位治疗剂量为100毫克（范围50至200毫克），肝总治疗量约为100毫克（范围20/30至200/300毫克）。接受过全身伊立替康治疗的患者中，18%发生了所有级别的不良事件，而未接受过全身伊立替康治疗的患者（包括未接受过化疗的患者）中这一比例为15%。接受过全身伊立替康治疗的患者在3个月时的缓解率为44%，6个月时为43%，12个月时为44%，而未接受过全身伊立替康治疗的患者在同一时间点的缓解率分别为45%、40%和35%。接受0、1、2和3线以上全身化疗的患者中，所有级别的不良事件发生率分别为10%、20%、10%和37%。接受0、1、2和3线以上全身化疗后接受DEBIRI治疗的患者，6个月时的总生存率分别为90%、93%、90%、90%，12个月时分别为76%、71%、77%、87%。
肝动脉载药伊立替康微球（DEBIRI）治疗的安全性和疗效不受之前全身伊立替康治疗无效的影响。虽然在未接受过化疗的个体中DEBIRI的完全缓解率最高且总体不良事件最少，但即使在之前接受过全身化疗的情况下，它仍保持着可观的疗效和较低的严重不良事件发生率。
