Background: Many people with colorectal cancer get liver metastases. Standard treatment for this is a combination of chemotherapy drugs. Directing the chemotherapy to the liver may be effective. A device that does this a pump that delivers drugs over 2 weeks at constant rate into the hepatic artery. The person's body temperature causes the drug to flow from the pump. Researchers want to see if this helps people with colorectal metastases to the liver. Objective: To study the effectiveness of a hepatic artery infusion pump at treating colorectal metastases to the liver. Eligibility: Adults at least 18 years old with colorectal metastases to the liver Design: Participants will be screened with: Medical history Physical exam Heart, blood, and urine tests Scans Participants will stay in the hospital a few days. A small plastic tube (catheter) will be inserted in an artery into the liver. The catheter will be attached to the pump. That will lie under the skin on the abdomen. It will be small and participants will be able to feel it. Participants will get treatment in 28-day cycles. Every Day 1, they will have physical exam, symptom review, and blood tests. Every 2 weeks, they will come to the clinic to get chemotherapy by a catheter or port. Every 12 weeks, they will have a scan. Tissue samples may be taken during the study. When they finish the drug, participants may have the pump removed. They will repeat the Day 1 tests. They will be called every 6 months to see how they are doing.
Background: * Nearly 60% of patients with colorectal cancers will develop liver metastases over the course of their disease. * Of patients with metastatic colorectal cancer, the liver will be the sole site of recurrence or the survival-limiting site of disease for 20%. * Liver directed therapy, which has taken many forms over the last several decades, is a potential means to prolong survival for properly selected patients and delay progression at that site. * Hepatic artery infusion of floxuridine (FUDR) via an implantable hepatic artery infusion pump (HAIP) induces objective clinical response rates of nearly 50% in heavily pre-treated patients with metastatic colorectal cancer to the liver. * The identification of patients likely to respond to HAIP and those likely to suffer pumprelated adverse events is currently unknown, and has limited the wide-spread adoption of this otherwise well tolerated intervention. Objective: * To assess the safety of hepatic artery infusion therapy using the Medtronic pump with the Codman catheter. * To determine the response rate in patients with unresectable metastatic colorectal cancer treated with HAIP chemotherapy as measured by the Response Evaluation Criteria in Solid Tumors (RECIST). Eligibility: * Histologically or cytologically confirmed colorectal adenocarcinoma metastatic to the liver. * Patients with liver metastases not amenable to resection to No Evidence of Disease (NED) in one stage. * Patients must have received systemic chemotherapy. * Age greater than or equal to 18 years. Design: \- Single arm, Phase II study of HAIP chemotherapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
24
Implanted Medtronic SynchroMed II Pump with codman 3000 Constant Flow Pump Catheter
6 mg/kg, intravenous (IV)
Hepatic Artery Infusion Pump (HAIP) will be filled with mixture of Floxuridine and Dexamethasone. Pump will perfuse drugs to liver for 14 days. Floxuridine (0.12 mg/kg X pump volume X pump flow rate), Dexamethasone (1 mg/day X pump volume (30) X pump flow rate)
85 mg/m\^2, intravenous (IV)
2000 mg/m\^2, intravenous (IV) 46-hour infusion of 5-Fluorouracil + 400 mg/m\^2, IV of Leucovorin
150 mg/m\^2, intravenous (IV)
Hepatic Artery Infusion (HAI) pump installation
500 mg/m\^2, intravenous (IV)
Implanted Medtronic SynchroMed II Pump with Codman 3000 Constant Flow Pump Catheter
Floxuridine 0.12 mg/kg X pump volume X pump flow rate
1 mg/day X pump volume (30) X pump flow rate
Screening and baseline.
Screening, baseline and Cycle 1. One cycle is 28 (+/- 2 days).
Screening
For research: During surgery to install pump, time of progression per principal investigator discretion if safe, and end of treatment.
400 mg/m\^2, intravenous (IV), (Day15, Day1)
National Institutes of Health Clinical Center
Bethesda, Maryland, United States
Response Rate (RR) Reported With an 80% Confidence Interval
Response rate is defined as the number of participants who experience a partial response (PR) or complete response (CR) using the study treatment was assessed using the Response Evaluation Criteria in Solid Tumors (RECIST) and reported with an 80% confidence interval. Partial Response is at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters. Complete Response is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm.
Time frame: 6 months
Response Rate (RR) Reported With a 95% Confidence Interval
Response rate is defined as the percentage of participants who experience a partial response (PR) or complete response (CR) using the study treatment determined by dividing the number of responders by the total evaluable participants. RR was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) and reported with an 95% confidence interval. Partial Response is at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters. Complete Response is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm.
Time frame: 6 months
Number of Grade 1, 2, 3, 4, and/or 5 Serious and/or Non-serious Adverse Events Reported With Type and Frequency
Safety was determined by grade 1, 2, 3, 4, and/or 5 serious and/or non-serious adverse events with type and frequency assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned. Grade 1 is mild. Grade 2 is moderate. Grade 3 is severe. Grade 4 is life-threatening. Grade 5 is death related to adverse event.
Time frame: 30 days
Overall Survival
OS is defined as the median amount of time a participant survives after therapy determined using the Kaplan Meier method. The 95% confidence intervals were obtained using the Brookmeyer-Crowley method via a log-log (complementary log-log) transformation. As pre-specified in the protocol Statistical Section 10.4.3 Analysis of the Secondary Efficacy Endpoints, Overall survival (OS) will be calculated "from the date the patient enrolled onto the trial." The Responsible Party's rationale for reporting a different time frame is "The RP's preference is to report from the date of pump insertion given the time variability from enrollment to surgery, which is a function of operating room (OR) availability, and nothing related to the study.
Time frame: Date of Hepatic Artery Infusion Pump (HAIP) insertion through death or study completion, up to 63.1 months
Intra-Hepatic Progression-free Survival (PFS)
Intrahepatic PFS is defined as the duration of time from date of operation to the date of first observation of progressive disease within the liver or death, whichever comes first. Progression was measured by the Response Evaluation Criteria in Solid Tumors and determined using the Kaplan Meier method. Progression is at least a 20% increase in the sum of the diameters of target lesions. The 95% confidence intervals were obtained using the Brookmeyer-Crowley method via a log-log (complementary log-log) transformation. As prespecified in the protocol Statistical Section 10.4.3 Intra-hepatic PFS will be calculated "from the date the patient enrolled onto the trial." The Responsible Party's (RP) rationale for reporting a different time frame is "The RP's preference is to report from the date of pump insertion given the time variability from enrollment to surgery, which is a function of operating room (OR) availability, and nothing related to the study.
Time frame: Date of hepatic artery infusion pump (HAIP) insertion through either the date of first hepatic progression or study completion, up to 63.1 months
Extra-hepatic Progression-free Survival (PFS)
Extra-hepatic PFS is defined as the duration of time from date of operation to the date of first observation of progressive disease outside of the liver or death, whichever comes first. Extra-hepatic PFS was determined using the KaplanMeier method\&reported with a 95% confidence interval. Progression was measured by the Response Evaluation Criteria in Solid Tumors. Progression is at least a 20% increase in the sum of the diameters of target lesions. The 95% confidence intervals were obtained using the Brookmeyer-Crowley method via a log-log(complementary log-log) transformation. As prespecified in the protocol Statistical Section 10.4.3Extra-hepatic PFS will be calculated "from the date the patient enrolled onto the trial." The Responsible Party's((RP) rationale for reporting a differently is "RP's preference is to report from the date of pump insertion given the time variability from enrollment to surgery,which is a function of operating room availability\¬hing related to the study.
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Time frame: Date of hepatic artery infusion pump (HAIP) insertion through either the date of first extra-hepatic progression or study completion, up to 63.1 months