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Evidence summaries

Fluoropyrimidine-Hai (Hepatic Arterial Infusion) Versus Systemic Chemotherapy (Sct) for Unresectable Liver Metastases from Colorectal Cancer

Fluoropyrimidine hepatic arterial infusion for the treatment of patients with unresectable colorectal cancer liver metastases might possibly not increase survival when compared with fluoropyrimidine-based systemic chemotherapy, although the evidence is insufficient. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 10 studies with a total of 1 277 subjects. Hepatic arterial infusion (HAI) regimens were based on floxuridine (FUDR) in 8 studies, 5-fluorouracil plus leucovorin in 1 study, and in the only three-arm trial, either FUDR or 5-fluorouracil + leucovorin. Systemic chemotherapy (SCT) consisted of FUDR in 3 and 5-fluorouracil (combined with leucovorin) in 7 studies. Tumor response rate favoured HAI (42.9% for HAI vs. 18.4% for SCT; RR 2.26, 95% CI 1.80 to 2.84; 9 studies, n=901). Mean weighted median overall survival times were 15.9 for HAI and 12.4 for SCT (HR 0.90, 95% CI 0.76 to 1.07; 10 studies, n=1277). There was significant heterogeneity across studies (I2 =85.2%).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), by inconsistency (variability in results across studies), and by indirectness (modern systemic chemotherapy can achieve higher response rates than the regimens used in the analyzed studies).

    References

    • Mocellin S, Pasquali S, Nitti D. Fluoropyrimidine-HAI (hepatic arterial infusion) versus systemic chemotherapy (SCT) for unresectable liver metastases from colorectal cancer. Cochrane Database Syst Rev 2009;(3):CD007823. [PubMed]

Primary/Secondary Keywords