37: Hepatic Artery Infusion Chemotherapy Compared to Y90 for Treatment of Unresectable Colorectal Liver Metastases: A Multi-Institutional Comparative Study

Thursday, March 23, 2023

10:16 AM – 10:26 AM

Location: Ballroom B

Abstract Presenter(s)

Lily V. Saadat, MD

Resident/Research Fellow
Memorial Sloan Kettering Cancer Center
Boston, Massachusetts, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Lily V. Saadat, MD

Resident/Research Fellow
Memorial Sloan Kettering Cancer Center
Boston, Massachusetts, United States

Disclosure(s): No financial relationships to disclose

Author(s)

JC

Joanne Chou, MPH

Senior Biostatistician
Department of Biostatistics, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
MG

Mithat Gonen, PhD

Chief of the Biostatistics Service
Department of Biostatistics, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Rachel M. Lee, MD, MSPH

General Surgery Resident
Emory University
Atlanta, Georgia, United States

Disclosure information not submitted.
Shishir K. Maithel, MD

Professor of Surgery
Emory
Atlanta, GA, United States

Disclosure information not submitted.
Amy Y. Li, MD (she/her/hers)

Resident
Stanford University School of Medicine, United States

Disclosure information not submitted.
George Poultsides, MD (he/him/his)

Chief, Section of Surgical Oncology; Professor of Surgery
Stanford University
Stanford, California, United States

Disclosure(s): No financial relationships to disclose
Taylor J. Aiken, MD

General Surgery Resident
University of Wisconsin Hospitals and Clinics
Madison, Wisconsin, United States

Disclosure information not submitted.
Patrick B. Schwartz, MD

General Surgery Resident and Postdoctoral Research Fellow
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States

Disclosure information not submitted.
DA

Daniel E. Abbott, MD

Professor
Division of Surgical Oncology, Department of Surgery, University of Wisconsin–Madison, United States

Disclosure information not submitted.
KR

Keenan J. Robbins, MBBS MPHS

Research Fellow
Washington University School of Medicine
St. Louis, Missouri, United States

Disclosure information not submitted.
Ryan C. Fields, MD

Chief, Surgical Oncology; Professor of Surgery
Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine
St.Louis, MO, United States

Disclosure information not submitted.
AP

Ashwini Paranjpe, MD

Resident
University of Miami, United States

Disclosure information not submitted.
JD

Jashodeep Datta, MD

Assistant Professor
University of Miami, United States

Disclosure information not submitted.
WJ

William R. Jarnagin, MD

Chief, Hepatobiliary Service; Leslie Blumgart Chair in Surgery
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
AC

Andrea Cercek, MD

Associate Attending
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
NK

Nancy E. Kemeny, MD

Attending
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
DS

Daniel Sze, MD, PhD

Professor of Interventional Radiology
Stanford University, United States

Disclosure information not submitted.
CS

Constantinos Sofocleous, MD PhD

Attending Physician, Interventional Oncology
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
MD

Michael I. D’Angelica, MD

Enid A. Haupt Chair in Surgery
Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.

Disclosure(s):

Lily V. Saadat, MD: No financial relationships to disclose

George Poultsides, MD: No financial relationships to disclose

Introduction: The most common liver-directed therapies for unresectable colorectal liver metastases (CRLM) include hepatic artery infusion (HAI) chemotherapy and radioembolization (Y90), but comparative efficacy and outcome data are sparse. The aim of this study was to evaluate outcomes for patients with unresectable CRLM undergoing HAI versus Y90.

Methods: Patients with unresectable CRLM treated with HAI at one high-volume center were compared with patients treated with Y90 at five other institutions. Patients treated with both modalities and with concurrent liver resection at time of pump placement were excluded. Propensity score 1:1 matching was performed within lines of chemotherapy received prior to treatment (treatment naïve; 1 line; 2 lines; 3-4 lines of chemotherapy) using baseline demographics, presence of extra-hepatic disease (EHD), disease-free interval, interval from primary disease diagnosis to HAI/Y90. Matched overall survival (OS) analysis was conducted using the frailty model to compare the two groups.

Results: A total of 708 HAI patients and 481 Y90 patients were identified. Patients were heavily pretreated, with 84% having received chemotherapy prior to locoregional intervention. HAI patients were younger (median age: 54 vs 62), more likely to be white (84% vs 70%) and have evidence of EHD at time of treatment (65% vs 61%). Of the 493 patients who had received 1 line of chemotherapy, 166 (34%) were matched. Among matched patients who received 1 line (n=166) or 2 lines of chemotherapy (n=160) prior to treatment, Y90 patients had a significantly increased risk of all-cause mortality compared to patients treated with HAI [HR:1.46 (95%CI:1.02-2.08) and HR:1.96 (95%CI:1.32-2.89)], respectively (Figure 1). More frequent conversion to resection (HAI vs Y90:1 line: 19% vs 5%; 2 lines: 24% vs 3%), and use of concurrent systemic chemotherapy (HAI vs Y90:1 line: 87% vs 37%; 2 lines: 79% vs 34%) were also seen in the HAI cohort. Among matched patients who received 3-4 lines of chemotherapy (n=100), there was no difference in OS between HAI and Y90 [HR:0.88 (95%CI:0.57-1.35)] and rate of conversion to surgery was 4% for both groups.

Conclusions: Compared to Y90, HAI therapy is associated with improved survival for patients after first- or second-line chemotherapy, although survival is not significantly different in the refractory setting.

Learning Objectives:

Upon completion, participants will be able to describe differences in baseline demographics between patients who received Y90 and HAI for unresectable colorectal liver metastases.
Upon completion, participants will be able to understand differences in survival between Y90 and HAI for patients with unresectable colorectal liver metastases.
Upon completion, participants will understand conversion to resection rates after Y90 and HAI for patients with unresectable colorectal liver