Treating primary liver cancer with hepatic arterial infusion of floxuridine and dexamethasone

Does the addition of systemic bevacizumab improve results?

Nancy E. Kemeny, Lawrence Schwartz, Mithat Gönen, Adam Yopp, David Gultekin, Michael I. D'Angelica, Yuman Fong, Dana Haviland, Alexandra N. Gewirtz, Peter Allen, William R. Jarnagin

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objectives: This study investigated the efficacy and safety of adding systemic (IV) bevacizumab (Bev) to hepatic arterial infusion (HAI) with floxuridine (FUDR)/dexamethasone (Dex) in unresectable primary liver cancer. Methods: Patients with unresectable intrahepatic cholangiocarcinoma (ICC) or hepatocellular carcinoma (HCC) were treated with HAI FUDR/Dex plus IV Bev. Results were compared to a recent study of HAI without Bev in a similar patient population. Results: Twenty-two patients (18 ICC, 4 HCC) were treated with HAI FUDR/Dex plus Bev; 7 (31.8%) had partial response and 15 (68.2%) had stable disease. Median survival was 31.1 months (CI 14.14-33.59), progression-free survival (PFS) 8.45 months (CI 5.53-11.05), and hepatic PFS 11.3 months (CI 7.93-15.69). In the previous trial with HAI alone (no Bev), the response was 50%; median survival, PFS, and hepatic PFS were 29.5, 7.3, and 10.1 months. In the present trial, bilirubin elevation (>2 mg/dl) was seen in 24% of patients and biliary stents were placed in 13.6%, versus 5.8 and 0%, respectively, in the HAI trial without Bev. Due to increased biliary toxicity, the trial was prematurely terminated. Conclusion: Adding Bev to HAI FUDR/Dex appeared to increase biliary toxicity without clear improvement in outcome (median PFS 8.45 vs. 7.3 months, and median survival 31.1 vs. 29.5 months, for HAI + Bev vs. HAI alone groups, respectively).

Original languageEnglish (US)
Pages (from-to)153-159
Number of pages7
JournalOncology
Volume80
Issue number3-4
DOIs
StatePublished - Jul 2011

Fingerprint

Floxuridine
Liver Neoplasms
Dexamethasone
Liver
Disease-Free Survival
Cholangiocarcinoma
Survival
Hepatocellular Carcinoma
Bevacizumab
Bilirubin
Stents

Keywords

  • Floxuridine
  • Hepatic arterial infusion
  • Hepatocellular carcinoma
  • Intrahepatic cholangiocarcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treating primary liver cancer with hepatic arterial infusion of floxuridine and dexamethasone : Does the addition of systemic bevacizumab improve results? / Kemeny, Nancy E.; Schwartz, Lawrence; Gönen, Mithat; Yopp, Adam; Gultekin, David; D'Angelica, Michael I.; Fong, Yuman; Haviland, Dana; Gewirtz, Alexandra N.; Allen, Peter; Jarnagin, William R.

In: Oncology, Vol. 80, No. 3-4, 07.2011, p. 153-159.

Research output: Contribution to journalArticle

Kemeny, NE, Schwartz, L, Gönen, M, Yopp, A, Gultekin, D, D'Angelica, MI, Fong, Y, Haviland, D, Gewirtz, AN, Allen, P & Jarnagin, WR 2011, 'Treating primary liver cancer with hepatic arterial infusion of floxuridine and dexamethasone: Does the addition of systemic bevacizumab improve results?', Oncology, vol. 80, no. 3-4, pp. 153-159. https://doi.org/10.1159/000324704
Kemeny, Nancy E. ; Schwartz, Lawrence ; Gönen, Mithat ; Yopp, Adam ; Gultekin, David ; D'Angelica, Michael I. ; Fong, Yuman ; Haviland, Dana ; Gewirtz, Alexandra N. ; Allen, Peter ; Jarnagin, William R. / Treating primary liver cancer with hepatic arterial infusion of floxuridine and dexamethasone : Does the addition of systemic bevacizumab improve results?. In: Oncology. 2011 ; Vol. 80, No. 3-4. pp. 153-159.
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abstract = "Objectives: This study investigated the efficacy and safety of adding systemic (IV) bevacizumab (Bev) to hepatic arterial infusion (HAI) with floxuridine (FUDR)/dexamethasone (Dex) in unresectable primary liver cancer. Methods: Patients with unresectable intrahepatic cholangiocarcinoma (ICC) or hepatocellular carcinoma (HCC) were treated with HAI FUDR/Dex plus IV Bev. Results were compared to a recent study of HAI without Bev in a similar patient population. Results: Twenty-two patients (18 ICC, 4 HCC) were treated with HAI FUDR/Dex plus Bev; 7 (31.8{\%}) had partial response and 15 (68.2{\%}) had stable disease. Median survival was 31.1 months (CI 14.14-33.59), progression-free survival (PFS) 8.45 months (CI 5.53-11.05), and hepatic PFS 11.3 months (CI 7.93-15.69). In the previous trial with HAI alone (no Bev), the response was 50{\%}; median survival, PFS, and hepatic PFS were 29.5, 7.3, and 10.1 months. In the present trial, bilirubin elevation (>2 mg/dl) was seen in 24{\%} of patients and biliary stents were placed in 13.6{\%}, versus 5.8 and 0{\%}, respectively, in the HAI trial without Bev. Due to increased biliary toxicity, the trial was prematurely terminated. Conclusion: Adding Bev to HAI FUDR/Dex appeared to increase biliary toxicity without clear improvement in outcome (median PFS 8.45 vs. 7.3 months, and median survival 31.1 vs. 29.5 months, for HAI + Bev vs. HAI alone groups, respectively).",
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AB - Objectives: This study investigated the efficacy and safety of adding systemic (IV) bevacizumab (Bev) to hepatic arterial infusion (HAI) with floxuridine (FUDR)/dexamethasone (Dex) in unresectable primary liver cancer. Methods: Patients with unresectable intrahepatic cholangiocarcinoma (ICC) or hepatocellular carcinoma (HCC) were treated with HAI FUDR/Dex plus IV Bev. Results were compared to a recent study of HAI without Bev in a similar patient population. Results: Twenty-two patients (18 ICC, 4 HCC) were treated with HAI FUDR/Dex plus Bev; 7 (31.8%) had partial response and 15 (68.2%) had stable disease. Median survival was 31.1 months (CI 14.14-33.59), progression-free survival (PFS) 8.45 months (CI 5.53-11.05), and hepatic PFS 11.3 months (CI 7.93-15.69). In the previous trial with HAI alone (no Bev), the response was 50%; median survival, PFS, and hepatic PFS were 29.5, 7.3, and 10.1 months. In the present trial, bilirubin elevation (>2 mg/dl) was seen in 24% of patients and biliary stents were placed in 13.6%, versus 5.8 and 0%, respectively, in the HAI trial without Bev. Due to increased biliary toxicity, the trial was prematurely terminated. Conclusion: Adding Bev to HAI FUDR/Dex appeared to increase biliary toxicity without clear improvement in outcome (median PFS 8.45 vs. 7.3 months, and median survival 31.1 vs. 29.5 months, for HAI + Bev vs. HAI alone groups, respectively).

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