The Use of Combination Oral Chemotherapy to Enable Quality Day-Patient Care among Colorectal Cancer (CRC) Patients with Unresectable Liver-only Metastases

Abstract Description

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Authors (including presenting author) :

Wong SMN1, Chiang CLA2, Yeung SYC1, Lee SFM1, Lee ASF1, Wong CSF1

Affiliation :

1 Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong 2 Department of Clinical Oncology, HKU-Shenzhen Hospital and the University of Hong Kong, Hong Kong

Introduction :

While the use conversion chemotherapy regimen comprising infusional 5-fluorouracil (5FU), Irinotecan, and Cetuximab (FOLIRI-C) has been well established to improve R0 resection and survival among colorectal cancer patients with unresectable liver-only metastases, few explored the alternative 5FU oral counterpart - Capecitabine, in combination use. The Tuen Mun Hospital Clinical Oncology Team developed a multi-disciplinary, day-patient service model with mCAPIRI-C (Capecitabine, Irinotecan, Cetuximab) to spare in-patient admissions, ease administration, enhance efficiency, and hence improve overall patients’ care.

Objectives :

(1) To evaluate long term safety and efficacy of mCAPIRI-C among CRC patients with unresectable liver-only metastases in comparison to international standards (2) To demonstrate the implementation of a multidisciplinary, day-patient service model to enhance robustness and to deliver quality healthcare

Methodology :

We performed a single-centre, retrospective cohort investigating the clinical outcomes of mCAPIRI-C among CRC patients with upfront unresectable liver-only metastases identified at Hepatobiliary Multidisciplinary meetings of Tuen Mun Hospital from June 2012 to June 2018. Serial evaluation of clinical, biochemical and radiological results were performed.

Result & Outcome :

mCAPIRI-C has achieved superior conversion rate of 62% among eligible patients (n=47), of which 45% subsequently underwent R0 resection and 13% underwent other curative interventions [radiofrequency ablation (RFA) / stereotactic ablative radiotherapy (SBRT)]. Overall radiological response rate was excellent (83%), of which 6% achieved complete response. Of those who have received potentially curative therapies (surgery/RFA/SBRT), a significant progression free survival gain of 15.1 months (p< 0.001) was seen, while overall survival has not been reached (p=0.002). Treatment was well tolerated with no treatment-related 60-day or 30-day post-operative mortalities, and had a strikingly low occurrence of grade 3 or above toxicities. With a median of 8 chemotherapy cycles received per patient, a total of 940 hospital admission days was saved, translating into improved patient ambulation and reduced in-patient load. We have demonstrated safety and efficacy of mCAPIRI-C that exceeds international standards using FOLIRI-C. It has laid a solid foundation to support the use of this day-patient regime among other CRC indications to maximize patients’ benefit and enhance service robustness.