Review of Intra-Arterial Therapies for Colorectal Cancer Liver Metastasis

The liver is frequently the most common site of metastasis in patients with colorectal cancer, occurring in more than 50% of patients. While surgical resection remains the only potential curative option, it is only eligible in 15–20% of patients at presentation. In the past two decades, major advances in modern chemotherapy and personalized biological agents have improved overall survival in patients with unresectable liver metastasis. For patients with dominant liver metastatic disease or limited extrahepatic disease, liver-directed intra-arterial therapies such as hepatic arterial chemotherapy infusion, chemoembolization and radioembolization are treatment strategies which are increasingly being considered to improve local tumor response and to reduce systemic side effects. Currently, these therapies are mostly used in the salvage setting in patients with chemo-refractory disease. However, their use in the first-line setting in conjunction with systemic chemotherapy as well as to a lesser degree, in a neoadjuvant setting, for downstaging to resection have also been investigated. Furthermore, some clinicians have considered these therapies as a temporizing tool for local disease control in patients undergoing a chemotherapy ‘holiday’ or acting as a bridge in patients between different lines of systemic treatment. This review aims to provide an update on the current evidence regarding liver-directed intra-arterial treatment strategies and to discuss potential trends for the future.

Low Grade Abdominal Leiomyosarcoma with Liver Metastasis: A Second Cancer Twenty Years after Treatment for Nasopharyngeal Cancer

Background: leiomyosarcoma is one of the most frequent soft tissues and abdominal-pelvic sarcomas however intra-abdominal leiomyosarcoma with liver metastasis remain a very rare disease. Case presentation: A 61 year-old man presented in February 2019 a recent history of abdominal pain and weight loss. Imagery showed a 5 cm abdominal mass with multiples liver lesions. Biopsy of the liver lesions concluded to a metastases of a low grade leiomyosarcoma. Surgical resection was deemed not possible due to anatomical restrictions and the patient received 6 cycles of systemic mono-chemotherapy with epirubicin. A CT scan performed after the chemotherapy showed a stable disease using RECIST criteria. Conclusions: In case of an unresectable liver metastasis palliative chemotherapy can be offered although it is widely recognized that leiomyosarcoma show moderate sensitivity to chemotherapy.

Targeted therapies for metastatic colorectal cancer (mCRC): A systematic review of cost-effectiveness (CE).

583 Background: Currently three targeted agents are available for the treatment of mCRC. Making the right choice requires balancing efficacy, safety, quality of life, and, in cost-constrained systems, cost. This study aims to determine the most cost effective treatment in each line of therapy for mCRC through systematic review of published CE analyses (CEA). Methods: Literature was searched in Medline, Cancerlit, EMBASE, Cochrane, CINAHL, BIOSIS, Web of Science, Tufts CEA registry, ASCO and ASCO GI for CEAs of the three mCRC targeted agents, cetuximab, bevacizumab, and panitumumab. Manuscripts from 2004-2011 and abstracts from 2009-2011, published in English and considering payer/societal perspectives were included. Incremental CE ratios (ICERs) were converted to US$ using 2010 purchasing power parity. Results: 15 models from six countries were identified. Mean incremental costs per quality adjusted life year (QALY) and per life year (LY) gained are shown in the Table. All four models evaluating cetuximab in 1st line therapy, and only one of the six in 2nd+ line therapy, were done among biomarker selected KRAS wild type patients. Cetuximab’s cost effectiveness in 1st line therapy was driven by its ability to convert initially unresectable liver metastasis to resectable. Conclusions: Lower ICERs appear to be associated with the use of a predictive biomarker and / or a sub patient population that can benefit the most from a treatment. With the KRAS biomarker and its potential curative benefit in patients with initially unresectable liver metastasis, cetuximab appears to be the most cost-effective targeted agent in 1st line mCRC treatment. In 2nd or later lines, direct CEA between the three agents in comparable biomarker selected patients are needed to determine the most cost effective agent. [Table: see text]