Nancy E. Kemeny, MD
Treating liver metastases in patients with metastatic colorectal cancer (CRC) remains a common and ongoing challenge. According to Nancy E. Kemeny, MD, approximately 70% of patients with metastatic CRC will develop liver metastases.
on Gastrointestinal Cancers, Kemeny, a medical oncologist at Memorial Sloan Kettering Cancer Center, discussed the combination of pump and systemic therapy as a liver-directed treatment option for patients with metastatic CRC.
OncLive: Please provide an overview of your presentation on liver-directed therapy for patients with metastatic CRC.
: I discussed direct treatment to the liver. Even though we have new and better drugs for the treatment of CRC, we still have patients who die from metastatic disease. The liver is the main area of metastatic disease. About 70% of patients with metastatic disease will have liver metastases, and some people will have only liver metastases. Therefore, one can think about directing chemotherapy into the liver to help those patients.
Another study that just came out very recently was by one of our surgeons who evaluated 2300 patients at our institution who had liver resection. Of those patients, 760 had pumps and 1500 did not. Comparing the 2 groups, he found that the group who had the pump had more metastases and nodes. However, when you look at the OS for the pump group, the median survival was 66 months, whereas the group who did not get the pump was 43 months. That's a big difference.
Are there other similar trials exploring this combined modality?
We are also doing this in cholangiocarcinoma. We are getting excellent results there with the pump alone and have about a 50% response rate and a median survival of 25 months, compared with only 11 months with systemic therapy alone.
One of the criticisms of this treatment is that there are not many large randomized studies. To do this kind of treatment you need more expert places with great surgeons, interventional experts, medical professionals, and so on. There should be a whole team set up. In the past, we were one of the only institutions doing this but now there is an institution in St. Louis that just recently started working with our protocol. They have done their own work in cholangiocarcinoma and have gotten the same results that we have. We will be presenting that data at the 2018 Gastrointestinal Cancers Symposium. Other institutions can do this, but they need to train. I am not suggesting that every institution do this but there are many places that can.
What is your vision for this type of treatment in the future?
We need to get more centers interested in this before we open more randomized trials. The doctor who conducted the big study of more than 2000 patients went back to the Netherlands to open a trial there investigating liver resection and pump versus no pump treatment.
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