Postoperative hepatic arterial chemotherapy in high-risk patients as adjuvant treatment after resection of colorectal liver metastases - a randomized phase II/III trial - PACHA-01 (NCT02494973)

Diane Goéré, Jean Pierre Pignon, Maximiliano Gelli, Dominique Elias, Léonor Benhaim, Frédéric Deschamps, Caroline Caramella, Valérie Boige, Michel Ducreux, Thierry de Baere, David Malka

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30 Scopus citations

Abstract

Background: After curative-intent surgery for colorectal liver metastases (CRLM), liver recurrence occurs in more than 60% of patients, despite the administration of perioperative or adjuvant chemotherapy. This risk is even higher after resection of more than three CRLM. As CRLM are mostly supplied by arterial blood flow, hepatic arterial infusion (HAI) of chemotherapeutic agents after resection of CRLM is an attractive approach. Oxaliplatin-based HAI chemotherapy, in association with systemic fluoropyrimidines, has been shown to be safe and highly active in patients with CRLM. In a retrospective series of 98 patients at high risk of hepatic recurrence (≥4 resected CRLM), adjuvant HAI oxaliplatin combined with systemic chemotherapy was feasible and significantly improved disease-free survival compared to adjuvant, 'modern' systemic chemotherapy alone. Methods/Design: This study is designed as a multicentre, randomized, phase II/III trial. The first step is a non-comparative randomized phase II trial (power, 95%; one-sided alpha risk, 10%). Patients will be randomly assigned in a 1:1 ratio to adjuvant systemic FOLFOX (control arm) or adjuvant HAI oxaliplatin plus systemic LV5FU2 (experimental arm). A total 114 patients will need to be included. The main objective of this trial is to evaluate the potential survival benefit of adjuvant HAI with oxaliplatin after resection of at least 4 CRLM (primary endpoint: 18-month hepatic recurrence-free survival rate). We also aim to assess the feasibility of delivering at least 4 cycles of HAI (or i.v.) oxaliplatin after surgical treatment of at least 4 CRLM, the toxicity (NCI-CTC v4.0) of adjuvant HAI plus systemic chemotherapy, including HAI catheter-related complications, compared to systemic chemotherapy alone, and the efficacy of adjuvant HAI on hepatic and extra-hepatic recurrence-free (survival and overall survival). Discussion: If 18-month hepatic recurrence-free survival is greater than 50% in the experimental arm, the study will be pursued in phase III, for which the primary endpoint will be 3-year recurrence-free survival rate. Patients randomized in the phase II will be included in the phase III, with an additional number of 106 patients. Trial registration: ClinicalTrials.gov, NCT02494973. Trial registration date: July 10, 2015.

Original languageEnglish
Article number787
JournalBMC Cancer
Volume18
Issue number1
DOIs
StatePublished - 6 Aug 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 The Author(s).

Funding

This study is financially supported by a governmental grant from the National Institute of Cancer (INCa), which grants the founding after evaluation by rapporteurs and by external evaluators (http://www.e-cancer.fr/ Institut-national-du-cancer/Appels-a-projets). The authors declare that they have no competing interests relative to this study. This study is sponsored by the intergroup PRODIGE (Fédération Française de Cancérologie Digestive and UNICANCER) and the intergroup FRENCH (Fédération de Recherche EN Chirurgie).

FundersFunder number
National Institute of Cancer
Unicancer
CNIB

    Keywords

    • Adjuvant chemotherapy
    • Colorectal cancer
    • Hepatic arterial infusion
    • Liver metastases
    • Liver resection
    • Oxaliplatin
    • Randomized trial

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