Conversion treatment with hepatic arterial infusion of oxaliplatin, leucovorin and fluorouracil plus intravenous bevacizumab or cetuximab for initially unresectable colorectal liver metastasis: A prospective study

OBJECTIVE: To evaluate the conversion to resection rate (CTRR), treatment safety and short-term oncological outcomes of FOLFOX-hepatic arterial infusion chemotherapy (FOLFOX-HAIC) plus intravenous bevacizumab or cetuximab for initially unresectable colorectal liver metastasis (IU-CRLM). METHODS: Data from a consecutive cohort of IU-CRLM patients who underwent conversion treatment using FOLFOX-HAIC with bevacizumab or cetuximab in Tongji Hospital were reviewed. The CTRR, tumor response, safety of drug treatment and surgery, potential predictive factors, and short-term oncological outcomes were got to preliminarily evaluate this conversion regimen. RESULTS: A consecutive cohort of 42 patients were screened, and finally, 19 patients were enrolled in the study. 13 patients successfully underwent liver resection, the CTRR was 68.4%. Patients in no resection group showed more ratio of prior chemotherapy and prior resection of primary tumor, reduced chemotherapy dose, worse tumor differentiation and more lymphvascular invasion than in resection group. Patients in resection group showed better tumor response, including overall response, objective response, largest tumor diameter and levels of tumor biomarkers after treatment, except for disease control rate, than in no resection group. The incidence of grade≥3 adverse event was 21.1% and no pharmacotherapy-related death occurred in HAIC. The median operative time was 265 min and no grade≥2 intraoperative incidents occurred. The incidence of postoperative complications was 23.1%, but serious complication rate was only 7.7% and no death occurred with 90 days after surgery. CONCLUSION: FOLFOX-HAIC was an effective and safe conversion treatment for IUCRLM without extrahepatic metastasis.