Hepatic Arterial Infusion Oxaliplatin After Colorectal Liver Metastasis Resection

Key Takeaways

• Longer hepatic recurrence-free survival was observed with HAI oxaliplatin plus IV LV5FU2 than with IV oxaliplatin plus IV LV5FU2 after surgery for four or more colorectal liver metastases.
• Recurrence-free survival also favored HAI, while overall survival numerically favored HAI without a statistically significant difference.
• Grade 3 to 4 adverse events were more frequent with HAI, no treatment-related deaths were reported, and delivery of at least four adjuvant cycles was similar between groups.

In a randomized phase II trial of postoperative hepatic arterial infusion with oxaliplatin after surgery of four or more colorectal liver metastases, postoperative hepatic arterial infusion oxaliplatin produced longer hepatic recurrence-free survival than intravenous oxaliplatin after curative-intent treatment of four or more colorectal liver metastases. Median hepatic recurrence-free survival was 25 months with HAI oxaliplatin and 12 months with IV oxaliplatin, with a hazard ratio of 0.63, a 95% CI of 0.40 to 0.99, and P = .047. Patients had undergone resection or ablation, and both groups received IV LV5FU2 for at least 3 months in this high-risk postoperative comparison.

The Journal of Clinical Oncology report included patients with ECOG performance status 0-1 after preoperative IV chemotherapy and curative-intent local treatment of at least four colorectal liver metastases. Investigators assigned participants 1:1 to HAI oxaliplatin (n = 50) or IV oxaliplatin (n = 49). IV fluorouracil and leucovorin accompanied oxaliplatin in both groups for at least 3 months after surgery or ablation. The primary endpoint was hepatic recurrence-free survival; recurrence-free survival, overall survival, safety, and feasibility were secondary endpoints in this postoperative high-risk population.

Median follow-up was 59 months, with an interquartile range of 45 to 71 months. Median recurrence-free survival was 14 months with HAI and 9 months with IV, with a hazard ratio of 0.63, a 95% CI of 0.41 to 0.97, and P = .03. Median overall survival was 74 months with HAI and 57 months with IV, with a hazard ratio of 0.61, a 95% CI of 0.33 to 1.12, and P = .11. Five-year overall survival was 62% in the HAI arm and 47% in the IV arm. Recurrence endpoints favored HAI, while the overall survival difference remained numerically favorable without statistical significance.

Safety findings moved in the opposite direction, with grade 3 to 4 adverse events reported in 58% of HAI patients and 32% of IV patients, with P = .02. No treatment-related deaths were reported in either group. Feasibility was similar by treatment delivery, with at least four adjuvant cycles completed by 81% of HAI patients and 78% of IV patients, with P = .75. Authors described the safety profile as acceptable within the trial experience. Higher toxicity with HAI occurred alongside comparable chemotherapy delivery across the two groups.

Investigators concluded that postoperative HAI oxaliplatin plus LV5FU2 improved hepatic recurrence-free survival after curative-intent surgery for colorectal liver metastases. They added that these findings support further evaluation in a phase III trial.