Colorectal Cancer Spread to Liver: No Longer a Death Sentence
At the time the study was designed, only 25% of patients with this type of cancer survived for two years; thus the study was designed to end at two years. The results were dramatic: after two years, 90% of the patients in the combined therapy group had no recurrence, compared to 60% of the patients in the group receiving the single therapy. The single-therapy patients were almost 2.5 times more likely to die after two years than combined therapy patients.
In an interview to provide objective comment, William R. Dinwoodie, MD, tells WebMD that the pump technique holds promise, but that this data is still preliminary. "The benefits aren't as clear at five years. I'd be interested in what is going to happen with the overall survival then. But yes, indeed, at two years it seems very promising," says Dinwoodie, a clinical oncologist at the H. Lee Moffitt Cancer Center in Tampa, Fla.
Kemeny notes that implantation of the pump is a procedure that requires significant expertise. She suggests that while the technique is gaining acceptance -- particularly after publication of the current study results in TheNew England Journal of Medicine -- its use likely will be limited to large cancer centers with expertise in treating this type of cancer.
After the liver, the lung is the most common site of metastasis from colorectal cancer. Kemeny's group now is combining the local liver pump with new, systemwide chemotherapies that work better on cancer that has spread to the lung.
The new technique has been tested only on patients with primary colorectal cancer that has spread to the liver. It is not intended for treatment of cancer that begins in the liver, although one of the techniques for treating primary liver cancer involves localized chemotherapy.
Dinwoodie says that in the near future, newly available chemotherapies will greatly change the management of colorectal cancer. "One of the interesting things happening in this year and the next is that new agents will be available," he tells WebMD. "They are not as good as we would like them to be, but they will add to the armamentarium. You want something that will work 100% of the time, but we don't have those. Response rates are higher with [new] combinations of drugs, and there may be some improvement in survival. We are having many more options than we used to."