E202: The Association of Pre-Hepatic Artery Infusion Pump Systemic Chemotherapy with Intrahepatic Floxuridine Tolerance

ePoster Abstract Author(s)

Omar A. Zaki, MD

Resident Physician
University of Kentucky College of Medicine Department of Surgery, United States

Submitter(s)

Omar A. Zaki, MD

Resident Physician
University of Kentucky College of Medicine Department of Surgery, United States

Author(s)

Omar A. Zaki, MD

Resident Physician
University of Kentucky College of Medicine Department of Surgery, United States
SE

Scott S. Ellis, PharmD

Clinical Pharmacist
University of Kentucky College of Pharmacy, United States
DD

Daniel Davenport, PhD

Statistician
University of Kentucky College of Medicine Department of Surgery, United States
MB

Mautin Barry-Hundeyin, MD

Surgical Oncologist
Division of Surgical Oncology, Department of Surgery, University of Kentucky, United States
Prakash K. Pandalai, MD (he/him/his)

Surgical Oncologist
Division of Surgical Oncology, Department of Surgery, University of Kentucky, United States
JK

Joseph Kim, MD

Professor and Chief of Surgical Oncology
Division of Surgical Oncology, Department of Surgery, University of Kentucky, Kentucky, United States
RP

Reema A. Patel, MD

Medical Oncologist
Department of Internal Medicine, University of Kentucky, United States
Michael J. Cavnar, MD

Surgical Oncologist
Division of Surgical Oncology, Department of Surgery, University of Kentucky
Lexington, Kentucky, United States

Introduction: Hepatic arterial infusion (HAI) chemotherapy is a highly effective liver-directed therapy for colorectal liver metastases and intrahepatic cholangiocarcinoma. Dose reductions are nearly universal among patients receiving HAI floxuridine (FUDR) due to hepatotoxicity, but actual dose density is highly variable. It is unknown whether the amount of pre-HAI systemic chemotherapy is associated with FUDR dose density.

Methods: We retrospectively reviewed the records of patients who underwent HAI pump placement between 5/2020 and 12/2022 at our institution. Pre-HAI chemotherapy agents and number of cycles were correlated with FUDR dose density, defined as the actual total dose of FUDR received divided by the expected total dose over 6 cycles (initial weight-based maximum dose x 6).

Results: Over this time period, 43 patients were identified who underwent HAI implantation. Prior to surgery, 34 patients underwent a median of 7 cycles of oxaliplatin, while 14 received a median of 11 cycles of irinotecan, 36 patients received 10.5 cycles of 5-fluorouracil (5-FU) or capecitabine, and 28 p</span>atients received 8.5 cycles of bevacizumab. The median number of FUDR cycles was 6 (range 1-18). The median dose density was 0.56 (mean 0.59). The number of p</span>re-HAI cycles of oxaliplatin, a drug with known hepatotoxicity, was not significantly associated with number of FUDR cycles (Spearman’s rho 0.085, p=0.587) or with dose density (Spearman’s rho 0.238; p=0.124). Likewise, pre-HAI cycles of irinotecan, another potentially hepatotoxic drug, was not associated with number of FUDR cycles (0.247; p=0.110) or dose density (0.235; p=0.130). The sum of oxaliplatin and irinotecan cycles (median 7) had no significant association (0.169; p=0.278), and a non-significant trend for dose density (0.278; p=0.071). Pre-HAI 5-FU/capecitabine or bevacizumab also had no association with either parameter.

Conclusions: Despite the known potential hepatotoxicity of certain systemic chemotherapy agents, among a small cohort of patients selected for HAI chemotherapy at a single institution, the amount of pre-HAI systemic chemotherapy was not significantly associated with FUDR dose density. A confirmatory study is planned in an international multi-center database.

Learning Objectives:

Describe some correlations between chemotherapy and hepatic arterial infusion tolerance
Define dose density in the context of chemotherapy treatment
Recognize the variability in patient tolerance of hepatic arterial infusion treatment