Unresectable liver metasases from colorectal cancer remains a therapeutic challenge. There is growing evidence to support intraarterial therapies in order to intensify treatment. In particular, Hepatic arterial infusion (HAI) of chemotherapy has been proposed for years, and is now a widely accepted treatment all over the world, and currently evaluated in first-line treatment in a phase III randomised trial. Related to increased lifetime of intraarterial catheter and efficient concomitant systemic treatment, more and more patients still have a liver limited disease and functional intraarterial catheter after failure of a first regimen of HAI. In these patients, additional line of HAI with another cytotoxic agent has never been evaluated, but could help to increase survival of patients and in some cases tumor response and secondary resecability.

We report here for the first time the use of an additional HAI line after failure of a HAI of oxaliplatin in a retrospective monocentric study.

Hepatic arterial infusion (HAI) chemotherapy with oxaliplatin is an accepted option in the management of colorectal cancer (CRC) with dominant liver metastases (LM). However, despite prolonged control, some patients experience disease progression. On the other hand, oxaliplatin leads to dose-limiting toxicity. In these cases, the use of a second-line HAI with an alternative drug has never been reported to date. We evaluated treatment outcomes in patients receiving second-line HAI with 5-FU or mitomycin C, after first-line HAI of oxaliplatin in heavily pretreated patients.

Between March 2010 and June 2016, this observational study included 24 patients with unresectable CRC LM and treated with HAI of 5-FU (17 patients) or mitomycin C (7 patients), after HAI of oxaliplatin.

Mean age was 61.7 years. Forty-two percent of patients (10/24) had extra-hepatic metastases and 75% (18/24) at least 8 liver metastases. Including HAI of oxaliplatin, all patients had previously received at least 2 lines of chemotherapy±targeted agents (100%) and 96% (23/24) received concomitant systemic therapies together with HAI of 5-FU or mitomycin C. The overall objective response rate and disease control rate were, respectively, 42% (10/24) and 71% (17/24). Median progression-free survival and overall survival (OS) were, respectively, 5.6 and 25.8 months; hepatic progression-free survival was 8.5months. Thirteen percent (3/24) of the patients received further curative intent treatment after HAI 5-FU and mitomycin C. No toxic death occurred and the toxicity profile was acceptable.

HAI of 5-FU or mitomycin C is an alternative option in patients with predominant CRC LM, when they experience disease progression or do not tolerate HAI of oxaliplatin.