Protocol Number: 01-C-0093
Patients 18 years of age or older with colorectal cancer that has spread to the liver, but not further, and cannot be removed surgically may be eligible for this study. Candidates will be screened with a physical examination, blood tests, electrocardiogram (EKG), chest X-ray, and imaging studies, such as X-ray studies, CT scan of the chest, abdomen and pelvis and MRI scan of the liver, to evaluate the tumor. All patients will undergo laparotomy-abdominal surgery to examine the tumor-and will then be randomized to one of two treatment groups. Group 1 will undergo liver perfusion and then receive local (direct to the liver) and systemic (through the bloodstream) chemotherapy. Group 2 will have local and systemic chemotherapy without prior liver perfusion. During either the laparotomy or IHP operation, patients will have a small catheter placed in the artery to the liver. This will be connected to either a liver port or pump (depending on what's best suited for the individual) for administration of the local chemotherapy. Group 1 After the laparotomy, group 1 patients will undergo IHP. In this procedure, catheters (plastic tubes) are placed into the large artery and vein that supply blood to the liver and carry blood away from it. This creates a separate circulation for the liver, similar to the heart-lung bypass in open-heart surgery. During the perfusion the pump pushes blood and melphalan (anti-cancer drug) through the liver for 1 hour. After the perfusion, the catheter for local chemotherapy is put in place. The entire operation takes between 6 and 8 hours. About 6 weeks after IHP, patients will receive systemic chemotherapy with irinotecan followed by fluorouracil (5-FU) through a catheter in a vein. 5-FU and leucovorin will also be given for the next 2 days. This regimen will be repeated every 48 days for 6 cycles unless the disease progresses or the treatment side effects are too severe to continue. Local therapy will begin 2 weeks after the first cycle of systemic therapy. This will consist of a combination of floxuridine and leucovorin given directly to the liver through the catheter placed during the IHP surgery. Heparin will also be given to prevent clot formation in the catheter, and the steroid dexamethasone will be given to reduce swelling in the liver. The drugs will be infused for 14 days. This treatment will be repeated every 48 days for 6 cycles and then every 28 days for another 6 cycles. [Note: The protocol (page14) says the systemic and local chemotherapy are given in 35-day cycles for 6 cycles; the consent form (pages 4 and 5) says the systemic chemotherapy is given in 48-day cycles for 6 cycles and the local chemotherapy is given in 48-day cycles for 6 cycles and then 28-day cycles for another 6 cycles for a total of 12 cycles.] Group 2 Seven days after the laparotomy, patients in this group will receive one cycle of local chemotherapy. Two weeks later they will begin systemic and local chemotherapy according to the same schedule as group 1. All patients will return to NIH 10 to 11 times the first year for treatment and evaluation. They will have X-rays and blood tests to assess side effects and treatment response.
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