Liver resection after irinotecan, 5-fluorouracil, and folinic acid for patients with unresectable colorectal liver metastases

Abstract

The main objectives of this study were to assess the use of irinotecan, 5-fluorouracil (5-FU), and leucovorin (FA) as neoadjuvant chemotherapy for patients with unresectable colorectal liver metastases and to determine the response rate and proportion of patients that could be downstaged to resectable tumors. Forty patients were treated with irinotecan (180 mg/m² over 30 min) on d 1, FA (200 mg/m² over 30 min) followed by 5-FU (400 mg/m² bolus and continuous infusion of 600 mg/m² over 22 h) on d 1 and 2 every 2 wk. The overall response rate was 55% (95% CI: 39.5–70.4%). The progression-free survival was 12.1 mo (95% CI: 11.4–14.8 mo). The median overall survival was 20 mo (95% CI: 17.7–26.6 mo). Four patients (10%) have undergone liver resection after a median of eight cycles. Those patients remained alive with a median follow up period of 33 mo. The principal grade 3–4 toxicity was neutropenia in 20 patients (50%). We conclude that the regimen of irinotecan/5-FU/FA was highly active in patients with colorectal cancer and liver metastases with limited toxicity. In a subgroup of patients with initial inoperable liver metastases, this regimen was able to downstage the disease to an operable stage.