Dr. Fakih on the Use of Regional Therapy in Colorectal Cancer

Marwan Fakih, MD, professor, Department of Medical Oncology and Therapeutics Research, associate director for Clinical Investigations, Comprehensive Cancer Center, medical director, Judy and Bernard Briskin Center for Clinical Research, co-director, Gastrointestinal Cancer Program, and section head, Gastrointestinal Medical Oncology, City of Hope, discusses the use of regional therapy in the treatment of patients with colorectal cancer (CRC).

There was a lot of excitement in the field regarding Yttrium-90 radioembolization, says Fakih, but the first-line studies were negative in terms of overall survival. The benefit with radioembolization for patients with refractory disease is quite limited, he adds. Given the fact that only small randomized studies have evaluated its use, this approach is unlikely to have a significant impact on future practice.

However, at City of Hope, investigators are looking at hepatic arterial infusion with 5-fluoro-2'-deoxyuridine. There is reason to believe that patients with refractory disease and limited liver metastases derive excellent responses to hepatic arterial infusion, says Fakih. This approach does not affect liver function to the same degree that radioembolization does and it results in deeper responses. Currently, it is underutilized as a treatment modality. With more awareness, Fakih is hopeful that the approach will become more widespread. However, he cautions the procedure should only be used in high-volume centers.