ALTERNATING FLOXURIDINE AND 5-FLUOROURACIL HEPATIC ARTERIAL CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES MINIMIZES BILIARY TOXICITY

BACKGROUND: The goals of this study of a hepatic arterial infusion (HA I) regimen of alternating floxuridine and 5-fluorouracil were to evalu ate the treatment-related toxic effects, the antitumor response rate, and patient survival. METHODS: Fifty-seven consecutive patients were t reated with implanted HAI pumps and received a regimen of alternating floxuridine (0.1 mg/kg/day continuous HAI for 7 days) followed by a we ekly HAI pump bolus of 5-fluorouracil (15 mg/kg for 3 weeks). Any chan ges in treatment plan because of toxicity, antitumor response, and sur vival were recorded. RESULTS: Thirty-one (54.4%) patients responded to this HAI regimen; 14 (24.5%) patients had stable disease, and 12 (21. 1%) progressed during treatment. Responders or patients with stable di sease had a significantly (P <0.05) improved survival rate (19 months median) compared with patients in whom disease progressed (12 months m edian). Two (3.5%) patients developed biliary sclerosis and 12 (21.1%) had mild transient liver function abnormalities. The liver alone or i n combination with another area was the site of first progression of d isease in 40 (70.2%) patients. CONCLUSIONS: This regimen had reversibl e or no hepatobiliary toxicity in more than 95% of patients, Tumor red uction or stabilization of disease was observed in 79% of the patients , who had a median survival of 19 months. Reduced toxicity and more ef fective chemotherapeutic regimens may increase the likelihood of survi val after HAI chemotherapy for unresectable colorectal liver metastase s.