A Case of Heavily Pretreated HER2+ Colorectal Liver Metastases Responsive to Hepatic Arterial Infusion Chemotherapy

IF 3.3 3区医学 Q2 ONCOLOGY Clinical colorectal cancer Pub Date : 2023-06-01 DOI:10.1016/j.clcc.2023.02.006

Ryan J. Beechinor , Mustafa F. Abidalhassan , Deborah F. Small , Huong K. Hoang , Ramit Lamba , Thomas W Loehfelm , Cameron C. Foster , Michael Z. Koontz , Edward Jae-Hoon Kim , May Cho , Sepideh Gholami

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引用次数: 0

Abstract

What is Already Known About This Subject?Hepatic arterial infusion (HAI) pumps represent 1 promising treatment strategy for patients presenting with liver only or predominant tumors. HAI therapy is a form of locoregional therapy which administers chemotherapy directly into the hepatic artery, thus limits systemic exposure and spares other organs from toxicity. According to the National Comprehensive Cancer Network Guidelines (NCCN), placement of a HAI pump, in combination with systemic chemotherapy, has a category 2B recommendation for centers with the requisite expertise to perform this procedure. However, the utility of HAI pumps for patients with previously treated relapsed/refractory colorectal cancer (CRC) with colorectal liver metastases (CRLM) remains unclear.
What are the New Findings?Here, we describe a case of heavily pretreated patient with CRC and CRLM unusually responsive to HAI chemotherapy. Our patient had a progression free survival (PFS) of 20.2 months with HAI therapy, versus a PFS of 3 to 6 months with systemic chemotherapy therapy. Furthermore, in this case, the patient has been able to stay off systemic therapy for over a year by the time of this publication. Based on the patient's response, HAI therapy may slow the rate of disease progression compared to other therapies, as it might “reset the clock” as it did for this patient's very aggressive biology.
How Might it Impact on Clinical Practice in the Foreseeable Future?We believe this to be the first published case report of a patient with previously treated HER2+ CRC who had progressed on anti-HER2 therapy, who had a substantial response from treatment with FUDR HAI chemotherapy. Our report adds to the dearth of the literature in this patient population, and supports use of HAI chemotherapy as a potential treatment strategy for patients with relapsed, refractory CRLM. This case suggests that HAI chemotherapy with FUDR in combination with systemic therapy has the potential to provide long-term responses even for patients with CRLM refractory to multiple lines of chemotherapy.

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一例严重预处理的HER2+结直肠癌肝转移对肝动脉灌注化疗的反应

关于这个主题已经知道什么？肝动脉输注（HAI）泵是一种很有前途的治疗策略，适用于仅肝脏或主要肿瘤患者。HAI治疗是一种局部治疗，将化疗直接应用于肝动脉，从而限制全身暴露，并使其他器官免受毒性影响。根据国家癌症综合网络指南（NCCN），对于具有执行该程序所需专业知识的中心，HAI泵的放置与全身化疗相结合具有2B类建议。然而，HAI泵对先前治疗过的复发/难治性癌症（CRC）伴结直肠癌肝转移（CRLM）患者的效用仍不清楚。新发现是什么？在这里，我们描述了一个严重预处理CRC和CRLM患者对HAI化疗异常反应的病例。我们的患者接受HAI治疗的无进展生存期（PFS）为20.2个月，而接受全身化疗的PFS为3-6个月。此外，在这种情况下，到本出版物发表时，患者已经能够在一年多的时间内停止系统治疗。根据患者的反应，与其他疗法相比，HAI疗法可能会减缓疾病进展的速度，因为它可能会像对待患者非常激进的生物学一样“重置时钟”。在可预见的未来，它将如何影响临床实践？我们认为，这是首次发表的既往接受过HER2+CRC治疗的患者的病例报告，该患者在抗HER2治疗方面取得了进展，并通过FUDR HAI化疗获得了实质性反应。我们的报告增加了该患者群体中文献的缺乏，并支持将HAI化疗作为复发、难治性CRLM患者的潜在治疗策略。该病例表明，即使对于对多种化疗方案难治的CRLM患者，FUDR联合全身治疗的HAI化疗也有可能提供长期疗效。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.