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Radioembolisation Therapy Shows Antitumour Effect and Survival Benefit in Patients With Colorectal Cancer Liver Metastases: Presented at SIR

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- March 25, 2008 -- In patients with colorectal cancer liver metastases that failed multiple chemotherapy regimens, treatment with ⁹⁰Yttrium (⁹⁰Y) resin microspheres is a valuable treatment option, resulting in a clear survival benefit with acceptable toxicity profile, researchers reported here at the Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting.

Tobias F. Jakobs, MD, Investigational Radiologist, Department of Clinical Radiology, University of Munich, Munich, Germany, presented the results in a talk on March 16 on behalf of colleagues at the University of Munich and their collaborators from the University of Texas M. D. Anderson Cancer Center, Houston, Texas.

"Our patients were heavily pretreated. They all had previously received standard-of-care chemotherapy, such as oxaliplatin-based regimens or irinotecan-based regimens; a majority of those patients had received capecitabine-based regimens, and/or monoclonal antibodies. In brief, our patients had failed polychemotherapy before they were referred for radioembolisation," said Dr. Jakobs.

Between 2003 and 2007, 30 men and 11 women with a mean age of 61 years underwent radioembolisation treatment with ⁹⁰Y resin microspheres via intra-arterial infusion administered in a single session as a whole-liver treatment.

"Interestingly, 54% of our patients have received liver-directed therapies in the earlier stage of their disease, and almost 20% of the patients we treated also had some limited extrahepatic disease, such as pulmonary metastases," explained Dr. Jakobs.

After treatment, tumour response was assessed by computed tomography/magnetic resonance imaging using Response Evaluation Criteria in Solid Tumours (RECIST) criteria. The researchers also assessed toxicity clinically and by laboratory work-up.

Median follow-up in this patient cohort was approximately 8 months and the mean follow-up was 1.5 years.

The researchers have pre- and post-procedural imaging data and laboratory follow-up results for 36 out of 41 patients.

Three months after radioembolisation, 61% of patients had stable disease, while 17% of patients had partial response to therapy. "Remarkably, only in 4 patients [9.8%] we observed progression of disease at 3 months after radioembolisation," noted Dr. Jakobs.

These response data are supported by the decrease in tumour size, a median of 29%. "For the very good responders the tumour shrank by 62%," said Dr. Jakobs.

Median overall survival (OS) in the 41 patients was 10.5 months.

Interestingly, those patients who responded to the treatment, in terms of reduction of the tumour marker levels, had much better median overall survival (OS = 19 months) compared with those who did not respond (OS = 5 months), noted Dr. Jakobs.

Toxicity data indicate that most patients had mild to moderate upper quadrant liver pain (n = 29), managed with appropriate medication. Other adverse events were grade 1 to 2 nausea (n = 16), gastric ulcers (n = 2), and grade 3 acute cholecistitis (n = 1). Grade 1 and 2 increases in transaminase levels were observed in most patients (n = 33), with no significant impairment of patients' quality of life.

"The survival data are very promising," said the session's moderator, Jeff H. Geschwind, MD, FSIR, Associate Professor of Radiology, Oncology and Surgery, Johns Hopkins University School of Medicine, and Division Chief, Interventional Radiology, Johns Hopkins Hospital, Baltimore, Maryland.

"However, we don't know yet where radioembolisation is in the treatment paradigm of colorectal cancer [liver] metastases, and further interdisciplinary studies are mandatory to prove [the efficacy of] this treatment," concluded Dr. Jakobs.

[Presentation title: Regional ⁹⁰Yttrium Microsphere Treatment of Chemotherapy-Refractory Colorectal Cancer Liver Metastases. Abstract 30]

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