— One in three trial patients serene alive at 3 years after hepatic arterial infusion pump medication
Mike Bassett, Group Creator, MedPage This day
January 20, 2024
SAN FRANCISCO — Hepatic arterial infusion pump (HAIP) chemotherapy with floxuridine tremendously improved overall survival (OS) in patients with developed intrahepatic cholangiocarcinoma (iCCA), in step with results from a phase II gaze.
Sufferers handled with HAIP chemotherapy combined with systemic chemotherapy accomplished a 1-365 days OS of 80% when in contrast with 47% within the historical cohort handled with systemic chemotherapy. The 3-365 days OS charges had been 33% and 3%, respectively, reported Bas Groot Koerkamp, MD, PhD, of the Erasmus MC Cancer Institute in Rotterdam, the Netherlands.
The results replicated previous phase II studies that evaluated the usage of HAIP chemotherapy in patients with developed iCCA, he seen.
“I favor to indicate that I attain fragment the fervour of all my colleagues within the room about immunotherapy and about focused therapies in intrahepatic cholangiocarcinoma,” Koerkamp stated in a presentation on the Gastrointestinal Cancers Symposium. “Then every other time, right now none of those therapies absorb proven a 3-365 days overall survival of one in three patients for developed disease. Furthermore, HAIP chemotherapy works no topic the genomic alterations.”
Koerkamp notorious that the same old of handle developed iCCA is systemic chemotherapy, declaring that in a subgroup analysis of the Developed Biliary Tract Cancer (ABC)-01, -02, and -03 trials, which analyzed the usage of gemcitabine and cisplatin for liver-confined iCCA, the median modified into 16.7 months, with 1-, 2-, and 3-365 days OS charges of 63%, 25%, and 3%, respectively.
This 3-365 days OS is the “benchmark,” now not supreme for unusual systemic therapies, but additionally for locoregional therapies, comparable to HAIP, he stated.
Koerkamp seen that the medication has been fascinated with various phase II studies, all of which demonstrated a constant response rate of about 50%, with 3-365 days OS charges ranging from 29% to 43%. Thus his community modified into having a gaze to replicate those ends up in basically the latest gaze.
With HAIP, surgeons implant a pump that is connected by a exiguous catheter into the hepatic artery, allowing for the supply of excessive-dose chemotherapy on to the liver whereas minimizing toxicities associated with systemic medication.
“The reason is that liver tumors assemble most of their blood supply from the hepatic artery as every other of the portal vein,” Koerkamp stated. “Furthermore, the drug floxuridine has a excessive first-scoot invent, allowing for a 200-fold higher publicity within the cancer cell.”
The gaze took instruct in three Dutch academic centers between January 2020 and September 2022 with 50 patients (median age 65) with unresectable iCCA confined to the liver. Two-thirds had multifocal disease and 22% had bought prior systemic chemotherapy. They bought 6 cycles of HAIP to boot to 8 cycles of systemic chemotherapy.
Amongst the 50 patients, forty eight started HAIP and 42 bought now not lower than 4 HAIP cycles. About one in 5 (22%) had a postoperative complication resolved with a reintervention.
Koerkamp and colleagues reported that a partial response modified into seen in 46% of patients, which modified into superior to gemcitabine/cisplatin on my own (21%), and much just like the charges seen within the published phase II trials evaluating HAIP.
Throughout a put up-presentation query and retort session, Benjamin Schlechter, MD, of the Dana-Farber Cancer Institute in Boston, requested how selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) compares with HAIP.
“If we take into yarn systemic therapy versus liver-directed therapy, it appears clear there could be a income to liver-directed therapy,” he stated. Schlechter requested Koerkamp for his influence of SIRT with Y-90 excited about that retrospective analyses of that contrivance “account 3-365 days survival that is graceful much like what you merely equipped.”
“The Y-90 results are barely impressive,” Koerkamp acknowledged. He notorious that whereas there absorb been no head-t0-head comparisons between Y-90 and HAIP, “I mediate the outcomes are serene better from the pump.”
“I mediate the records is more strong,” he stated, adding that a predominant good thing about HAIP is that it “treats the full liver.”
“We attain use SIRT as smartly if we absorb now a orderly lesion within the liver that is encroaching on the hilum and we are capable of now not offer the patient the pump,” Koerkamp stated.
Mike Bassett is a workers author specializing in oncology and hematology. He relies fully fully in Massachusetts.
Koerkamp disclosed institutional analysis funding from Tricumed.
Gastrointestinal Cancers Symposium
Supply Reference: Franssen S, et al “Hepatic arterial infusion pump chemotherapy in patients with developed intrahepatic cholangiocarcinoma confined to the liver: A multicenter phase II trial” GiCS 2024; Abstract 433.