Transarterial Yttrium-90 Radioembolization with Chemotherapy for the Treatment of Colorectal Liver Metastasis: The EPOCH Study - Episode 1

Treatment Options for Colorectal Cancer with Liver Metastasis

Mary F. Mulcahy, MD, describes the treatment options available for colorectal cancer with liver metastasis in the first and second line.

Mary F. Mulcahy, MD: Hello, I’m Mary Mulcahy from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Liver metastasis is the most common site of metastases for colorectal cancer. Standard treatment involves systemic chemotherapy with multidrug agents and often biologic agents in addition, either a VEGF [vascular endothelial growth factor] or an EGFR [epidermal growth factor receptor] inhibitor. In a small number of cases, immunotherapy may be beneficial. For liver-only disease, we try to incorporate liver resection when possible. However, of all patients with metastatic disease to the liver, about 80% aren’t amenable to any surgical intervention or local ablative therapy intervention. For those, we’re seeking out other treatments to enhance the effects of the chemotherapy on liver-only metastasis. Right now, the standard of care therapy is multiagent systemic chemotherapy with a biologic agent. When there’s disease confined to a small area, to a lobe, or perhaps multilobar disease, some of it may be amenable to surgical resection or ablative therapy. However, the majority of these cases aren’t.

Patients who have liver-only disease may have disease isolated to 1 section of the liver, or they may have diffuse metastatic disease. Patients with diffuse metastatic disease throughout multiple lobes of the liver often don’t have a local ablative option. For those who have disease isolated to or perhaps predominant in 1 lobe of the liver and minimal disease in the other lobe, with lots of intervention and a good response to therapy, we may be able to clear the liver of all disease. That might require using things like hepatic artery infusion or ablative techniques. There are a number of different techniques that have been used in the liver to try to clear it of all disease. However, for those cases that are multifocal in multiple lobes—bilobar, multifocal disease—oftentimes, liver-directed therapies with ablation or surgery won’t clear all disease. It will leave disease behind.

Transcript edited for clarity.