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Hepato-pancreato-biliary

E296: Outcomes of hepatic artery-based therapies and systemic multiagent chemotherapy in unresectable colorectal liver metastasis: A systematic review and meta-analysis

    ePoster Abstract Author(s)

  • Kavin Sugumar, MD (he/him/his)

    Resident
    Department of Surgery, Tulane University School of Medicine, Louisiana, United States

    • Submitter(s)

  • Kavin Sugumar, MD (he/him/his)

    Resident
    Department of Surgery, Tulane University School of Medicine, Louisiana, United States

    • Author(s)

  • Kavin Sugumar, MD (he/him/his)

    Resident
    Department of Surgery, Tulane University School of Medicine, Louisiana, United States

  • HS

    Henry Stizel, BS

    Medical Student
    2. Case Western Reserve University School of Medicine, Cleveland, OH, United States

  • VW

    Victoria Wu, BA

    Medical Student
    2. Case Western Reserve University School of Medicine, Cleveland, OH, United States

  • MC

    Madison Conces, MD

    Assistant Professor
    3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • ML

    Melissa Lumish, MD

    Assistant Professor
    3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • DB

    David Bajor, MD

    Assistant Professor
    3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • LH

    Lauren Henke, MD

    Assistant Professor
    3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • SC

    Sakti Chakrabarti, MD

    Assistant Professor
    3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • AM

    Amit Mahipal, MD

    Assistant Professor
    3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • JA

    John B. Ammori, MD

    Associate Professor
    4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • JH

    Jeffrey M. Hardacre, MD

    Professor
    4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • JW

    Jordan M. Winter, MD, MBA

    Professor
    4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • JS

    Jennifer Selfridge, MD, PhD

    Assistant Professor
    3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

  • LO

    Lee M. Ocuin, MD

    Associate Professor
    4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

Introduction:

Treatment of unresectable colorectal liver metastasis (UCRLM) includes hepatic artery-based therapies (HABT) and systemic multi-agent chemotherapy (CT) regimens, alone or in combination. A comprehensive analysis capturing the long-term outcomes of these treatment options has not been performed.


Methods:

A systematic review and meta-analysis was performed to calculate pooled long-term outcomes of commonly used therapies for UCRLM. We performed separate searches for studies of hepatic artery infusion with systemic chemotherapy (HAI-S), transarterial chemoembolization (TACE), transarterial radioembolization (TARE), FOLFOX/FOLFIRI, and FOLFOXIRI. Primary outcomes were overall survival (OS) and progression-free survival (PFS). Secondary outcomes were conversion to resection (CTR) and response rate (RR).


Results:

We reviewed 800, 954, 882, and 272 studies, of which 32, 27, 33, and 14 publications met inclusion criteria in the HAI-S, TACE, TARE, and CT arms. These studies included a total of 1691, 2415, 3534, 1712 patients respectively. The 6-/12-/24-/36-month OS estimates for HAI-S, TACE, TARE, FOLFOX/FOLFIRI, FOLFOXIRI were 97%/80%/54%/35%, 89%/67%/34%/14%, 73%/47%/24%/16%, 96%/83%/53%/36%, and 96%/93%/72%/55%. Similarly, the 6-/12-/24-/36-month PFS estimates were 74%/44%/19%/14%, 56%/22%/12%/4%, 56%/25%/12%/8%, 69%/30%/12%/7%, and 88%/55%/18%/11%. The CTR among the arms were 31%, 9%, 1%, 35%, and 53%. The RR was 49%, 42%, 32%, 50%, and 80%. Most of the chemotherapy studies (76.2%) were testing regimens in the first-line setting, whereas most HAI-S studies (76.3%) included pre-treated patients. On subgroup analysis of patients in the first-line setting with liver-only metastatic disease, the HAI-S arm had comparable pooled outcomes to patients treated with FOLFOXIRI, and HAI-S appeared to outperform doublet chemotherapy regimens (Figure).


Conclusions:

There exist multiple treatment options for patients with UCRLM. Patients treated with TACE or TARE appear to have generally poor OS, PFS, and low CTR. The body of evidence for HABT is mostly comprised of non-randomized, single arm, retrospective studies. HAI-S is an effective treatment for UCRLM, with promising outcome in both pre-treated patients and first-line settings.

Learning Objectives:

  • Various available hepatic artery based therapies and chemotherapy for unresectable colorectal liver metastasis (UCRLM)
  • Outcomes of hepatic artery based therapies and chemotherapy for UCRLM - OS, PFS, RR, conversion to resection
  • Aid in clinical decision making in treatment in UCRLM, toxicity of the various treatments