New treatment may be a better option for colon cancer patients

Targeted radioembolization combined with chemotherapy improved progression-free survival in patients with colon cancer that metastasized to the liver, according to a study published in the Journal of Clinical Oncology.

Most patients with colorectal liver metastases (CLM) are poor candidates for resection surgery, so this new treatment might be a better option over chemotherapy alone, according to Mary Mulcahy, MD, ’00 GME, professor of medicine in the division of Hematology and Oncology and lead author of the study.

“We know that systemic chemotherapy will eventually fail, so we are looking for a non-surgical treatment that can treat these patients,” said Mulcahy, who is also professor of radiology and surgery in the organ transplant division and a member of Robert H. Lurie Comprehensive Cancer Center at Northwestern University.

Riad Salem, MD, chief of vascular and interventional radiology and vice president of image-guided therapy in the department of radiology, and fellow of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University, was the senior author of the study.

About 60% of patients diagnosed with colorectal cancer will eventually see their cancer spread, with the liver being the main site of spread. While colon cancer is often treatable with surgical resection, diffuse liver metastases are much less amenable to surgical treatment.

The cancer is either distributed in a way that it cannot be operated on safely, or the size of the lesions makes it impossible. “

Mary Mulcahy, MD, lead author of the study

The standard treatment for colon cancer that has spread outside the colon is chemotherapy. Treatment with chemotherapy is limited by side effects and possible resistance, according to Mulcahy.

In the current study, the researchers combined chemotherapy with transarterial radioembolization (TARE), in which patients are infused with small glass microspheres, into which a radioactive isotope – yttrium-90 – is embedded. The microspheres are directed to the hepatic artery and from there travel to the liver, where they embed themselves in the small blood vessels of the tumor and radiate the cancer.

A total of 428 patients at 95 centers in North America, Europe and Asia with colon cancer spread to the liver only were randomly assigned to chemotherapy with or without TARE. Patients receiving chemotherapy and ART had longer progression-free survival. It is important to note that the addition of TARE did not impact their ability to receive further treatment, which worried the researchers.

Adding TARE to chemotherapy did not improve overall survival. Some patient subgroups benefited more from TARE than others. Characteristics that can identify patients who might benefit from adding TARE are the location of the original colon tumor, the genetic makeup of the tumor, and the amount of tumor in the liver. Ongoing studies will identify the patients most likely to benefit from this therapy, Mulcahy said.

This study was supported by Boston Scientific.

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