Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

P.J. Karanicolas, P. Metrakos, K. Chan, T. Asmis, E. Chen, T.P. Kingham, N. Kemeny, G. Porter, R.C. Fields, J. Pingpank, E. Dixon, A. Wei, S. Cleary, G. Zogopoulos, C. Dey, M. D'Angelica, Y. Fong, S. Dowden, Y.J. Ko

Abstract


Despite significant improvements in systemic therapy for patients with colorectal liver metastases (crlms), response rates in the first-line setting are not optimal, and response rates in the second-line setting remain disappointing. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms, but it remains infrequently used.

We convened an expert panel to discuss the role of haip in the contemporary management of patients with crlm. Using a consensus process, we developed these statements:

• haip chemotherapy should be given in combination with systemic chemotherapy.

• haip chemotherapy should be offered in the context of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing, and nuclear medicine.

• haip chemotherapy in combination with systemic therapy should be considered in patients with unresectable crlms who have progressed on first-line systemic treatment. In addition, haip chemotherapy is acceptable as first-line treatment in patients with unresectable colorectal liver metastases.

• haip chemotherapy is not recommended in the setting of extrahepatic disease outside the context of a clinical trial.

• haip chemotherapy in combination with systemic therapy is an option for select patients with resected colorectal liver metastases. These consensus statements provide a framework that clinicians who treat patients with crlm can use when considering treatment with haip.

 


Keywords


Colorectal metastases; liver metastases; unresectable metastases; adjuvant chemotherapy; intraarterial chemotherapy; hepatic arterial infusion pump chemotherapy

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DOI: http://dx.doi.org/10.3747/co.21.1577






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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)