Hepatic Artery Infusion Pump Chemotherapy With Floxuridine and Dexamethasone in Combination With Systemic Chemotherapy for Patients With Colorectal Cancer Metastatic to the Liver

Last updated: April 10, 2025
Sponsor: National Cancer Institute (NCI)
Overall Status: Active - Not Recruiting

Phase

2

Condition

Colon Cancer

Colorectal Cancer

Carcinoma

Treatment

Panitumumab

Codman 3000 constant flow pump catheter

5FU

Clinical Study ID

NCT03366155
180024
18-C-0024
  • Ages > 18
  • All Genders

Study Summary

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.

Eligibility Criteria

Inclusion

  • INCLUSION CRITERIA:

  • Patients must have histologically or cytologically confirmed diagnosis of colorectaladenocarcinoma.

  • Patients must have measurable liver metastatic disease.

  • Patients must have progressed on, been intolerant of or have residual disease afteroxaliplatin- or irinotecan-containing, fluorouracil-based, chemotherapeutic regimen.

  • Age greater than or equal to 18 years.

  • ECOG performance status less than or equal to 1

  • Patients must have adequate organ and marrow function as defined below:

  • leukocytes > 3,000/mcL

  • absolute neutrophil count > 1,500/mcL

  • platelets > 90,000/mcL

  • total bilirubin < 1.5 X institutional upper limit of normal

  • AST(SGOT)/ALT(SGPT) < 2.5 X institutional upper limit of normal

  • creatinine within normal institutional limits OR eGFR within normal aspredicted by the CKD-EPI equation > 60 mL/min/1.73 m2.

  • The hepatic artery infusion pump chemotherapy has potential teratogenic and/orabortifacient effects. For this reason, women of child-bearing potential and menmust agree to use adequate contraception (hormonal or barrier method of birthcontrol; abstinence) prior to study entry, for the duration of study participationand after completion of study treatment : 3 months after the last study drug formen; 6 months after the last study drug for women. Should a woman become pregnant orsuspect she is pregnant while she or her partner is participating in this study, sheshould inform her treating physician immediately.

  • Arterial anatomy on CT angiogram amenable to placement of the HAIP.

  • Ability of subject to understand and the willingness to sign a written informedconsent document.

  • HIV-positive patients may be considered for this study only after consultation withan HIV trained physician.

  • Patients must agree to co-enroll on the Surgical Oncology Program s tissuecollection protocol 13C0176, 'Tumor, Normal Tissue and Specimens from PatientsUndergoing Evaluation or Surgical Resection of Solid Tumors'

Exclusion

EXCLUSION CRITERIA:

  • Patients with liver metastases amenable to resection to No Evidence of Disease (NED)in one stage.

  • Patients who are receiving any other investigational agents.

  • Patients with incontrovertible radiographic evidence of disease outside of thecolon/rectum (primary) and liver given unlikelihood of benefit from liver-directedtherapy.

Note: The exception to this exclusion is patients with fewer than five lung lesions greater than 1 cm that have not increased in size by more than 10% over a 4-month period of time, and are amenable to resection should subsequent problematic growth occur. Lesions less than 1 cm are indeterminant as far as etiology is concerned and will be ignored. Patients with liver metastases and oligometastatic lung lesions (we define oligometastatic as less than 5 amenable to thoracoscopic removal) are still likely to benefit from liver directed therapy.

  • Patients who have undergone extra-hepatic metastasectomy and have a documenteddisease-free interval less than or equal to 4 months.

  • MSI-high patients who need to be treated with check-point inhibitors

  • Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that would limit compliancewith study requirements. This also includes any condition, including the presence oflaboratory abnormalities, which in the opinion of the Principal Investigator placesthe subject at unacceptable risk if they were to participate in the study orconfounds the ability to interpret data from the study.

  • Active concurrent malignancies within the last five years other than colorectalprimary except basal cell skin carcinoma and thyroid carcinoma.

  • Prior radiation to liver.

  • Pregnant women are excluded from this study because of the potential for teratogenicor abortifacient effects of the HAIP chemotherapy. Because there is an unknown butpotential risk for adverse events in nursing infants secondary to treatment of themother with HAIP, breast-feeding should be discontinued if the mother is treated.These potential risks may also apply to other agents used in this study. Lactatingwomen must-not breastfeed during study treatment and until at least 7 days after thefinal dose of study drug(s).

  • Patients with active Hepatitis B or C infection because of the potential forincreased liver toxicity given the damaging effects of the virus.

  • History of allergic reactions attributed to compounds of similar chemicalcomposition to FUDR or heparin.

Study Design

Total Participants: 24
Treatment Group(s): 9
Primary Treatment: Panitumumab
Phase: 2
Study Start date:
June 24, 2019
Estimated Completion Date:
January 31, 2027

Study Description

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 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.

Connect with a study center

  • National Institutes of Health Clinical Center

    Bethesda, Maryland 20892
    United States

    Site Not Available

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