Marlo Blazer

Yttrium-90 Radioembolization as Salvage Therapy for Colorectal Cancer With Liver Metastases

BACKGROUND Few patients with metastatic colorectal cancer (mCRC) are candidates for resection of their hepatic disease. Yttrium-90 ((90)Y) radioembolization has promise in the treatment of unresectable mCRC. We conducted a retrospective study to assess the efficacy in patients with refractory mCRC who underwent (90)Y radioembolization. MATERIALS AND METHODS Patients with unresectable mCRC with liver metastases treated at The Ohio State University were included in this analysis. Demographic data, carcinoembryonic antigen (CEA) values, observed toxicities, and information on prior therapies were collected. Response was assessed by RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. RESULTS Twenty-four patients (median age, 63 years) were included. Of the patients, 54% had extrahepatic disease; 67% had bilobar involvement. The patients had received a median of 3 prior therapies. No objective responses were observed. Five patients had a CEA response. Median PFS and OS were 3.9 months (95% CI, 2.4-4.8 months) and 8.9 months (95% CI, 4.2-16.7 months), respectively. Patients older than 65 years had improved PFS (4.6 vs. 2.4 months) and OS (14 vs. 5.5 months) vs. younger patients, likely due to receipt of (90)Y treatment earlier in their disease course. The presence of extrahepatic disease and the absence of CEA response appeared negatively predictive of efficacy. Toxicities were expected and manageable. CONCLUSION (90)Y radioembolization is active in select patients with refractory mCRC and with liver metastases, and is safe and well tolerated in the elderly. In patients with extensive extrahepatic disease, (90)Y should be used in combination with chemotherapy. CEA may be a predictor of efficacy.

Antiemetic Control with Palonosetron in Patients with Gastrointestinal Cancer Receiving a Fluoropyrimidine-Based Regimen in Addition to Either Irinotecan or Oxaliplatin: A Retrospective Study

Background: For moderately emetogenic chemotherapy, palonosetron (PALO) is reported to provide complete control of chemotherapy-induced nausea and vomiting (CINV) in 69% of patients. Prior to August 2009, our gastrointestinal (GI) cancer patients receiving the moderately emetogenic compounds oxaliplatin or irinotecan plus a fluoropyrimidine regimen received ondansetron and dexamethasone orally on day 1 of chemotherapy for CINV prevention. Beginning in August of 2009, ondansetron was replaced by PALO 0.25 mg (intravenous push). Methods: This is a single-institution retrospective study of GI cancer patients who received oxaliplatin or irinotecan plus a fluoropyrimidine. Failure of an antiemetic regimen was defined as grade ≥1 vomiting or grade ≥2 nausea (Common Terminology Criteria for Adverse Events, version 3) on days 1 through 5 following chemotherapy. Patients were divided for analysis into pre-PALO and post-PALO cohorts. Fisher’s exact test compared cohort differences. Results: A total of 305 patients were included in the study, with 157 patients in the pre-PALO cohort and 148 in the post-PALO cohort. For all patients, the risk of antiemetic failure was reduced from 50.3% [95% confidence interval (CI) 42.2–58.4%] to 28.4% (95% CI 21.3–36.4%) with PALO. This reduction in the relative risk of antiemetic failure was observed in all subgroups. Conclusion: The addition of PALO may provide increased control of CINV for the moderately emetogenic regimens of oxaliplatin or irinotecan plus a fluoropyrimidine in GI cancer patients.

Successful Completion of Adjuvant Chemotherapy in a Patient With Colon Cancer Experiencing 5-Fluorouracil–Induced Cardiac Vasospasm

Fluoropyrimidines are the chemotherapy backbone in the treatment of adenocarcinoma of the colon. Adjuvant 5-fluorouracil (5-FU)/leucovorin (LV) has been shown to significantly increase recurrence-free survival compared to surgery alone for patients with stage III colon cancer. Furthermore, the addition of oxaliplatin to 5-FU/LV (FOLFOX) in the adjuvant setting has been shown to provide an improved disease free survival compared to adjuvant 5-FU/LV therapy alone. Cardiotoxicity associated with 5-FU or capecitabine is a rare but serious adverse effect that can present as cardiomyopathy, vasospastic angina, coronary thrombosis and dissection, ventricular arrhythmias, and sudden cardiac death. We report a case of successful completion of adjuvant FOLFOX therapy in a patient who experienced 5-FU einduced cardiotoxicity. This was completed through aggressive inpatient supportive care and cardiac monitoring. The patient showed no signs of delayed cardiotoxicity or colon cancer recurrence at 10-month follow-up.