title: Complete pathological response of unresectable liver metastases from colorectal cancer after trans-arterial chemoembolization with drug-eluting beads loaded with irinotecan (DEBIRI) and concomitant systemic FOLFOX: A case report from the FFCD 1201 trial.
abstract: BACKGROUND
  Most liver metastases from colorectal cancer (CRC) are unresectable at diagnosis. Systemic chemotherapy allows secondary surgical resection in 10 to 20% of patients. Hepatic intra-arterial treatments could enhance response and resection rate. We therefore designed a prospective phase II trial testing the transarterial chemoembolization (TACE) using drug-eluting beads loaded with irinotecan (DEBIRI) with concomitant systemic FOLFOX regimen, the FFCD 1201 trial, in patients with liver limited metastatic CRC.
  
  
  METHODS
  A 48-year old patient was operated from an occlusive sigmoid adenocarcinoma. Magnetic resonance imaging showed 6 bilobar liver metastasis. The patient was considered as non-eligible for surgery initially. Patient was included in the FFCD 1201 trial and received 5 cycles of FOLFOX and 2 sessions of DEBIRI, with a quite good tolerability. Post-treatment evaluation showed a partial response and sufficient tumor shrinkage to make liver metastasis resectable. Right hepatectomy associated with wedge resection in the left liver was performed and pathological findings showed a complete pathological response (CPR).
  
  
  CONCLUSIONS
  Combination of DEBIRI with FOLFOX could increase tumor shrinkage leading to secondary resection of liver metastases from CRC. This combination may also, as shown here for the first time in a patient with unresectable LM, induce CPR of all LM, known to be associated with better outcome. Our case also emphasizes the difficulty to morphologically assess pathological response and the need for new tool to better select patients who should be resected. Further results of the FFCD 1201 trial will bring more information on this new combination therapy.
authors.affiliation: Department of Gastroenterology and Digestive Oncology, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Pernot
authors.affiliation: Department of Gastroenterology and Digestive Oncology, Jean-Mermoz Hospital, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Artru
authors.affiliation: Department of General and Digestive Surgery, Jean-Mermoz Hospital, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Mithieux
authors.affiliation: Department of Radiology, Jean-Mermoz Hospital, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Marsot
authors.affiliation: Department of Pathology, La-Croix-Rousse Hospital, Lyon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Watkin
authors.affiliation: Department of Interventional Radiology, Georges-Pompidou European Hospital, AP-HP, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pellerin
authors.affiliation: Department of Gastroenterology and Digestive Oncology, Jean-Mermoz Hospital, Lyon, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Lledo
authors.affiliation: Department of Pathology, La-Croix-Rousse Hospital, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chalabreysse
authors.affiliation: Department of Gastroenterology and Digestive Oncology, Jean-Mermoz Hospital, Lyon, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Desramé
authors.affiliation: Department of Gastroenterology and Digestive Oncology, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France. Electronic address: jtaieb75@gmail.com.
authors.forename: Julien
authors.initials: J
authors.lastname: Taieb
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology*; D004337:Drug Carriers; D005472:Fluorouracil / Q000627:therapeutic use; D006499:Hepatic Artery; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D011446:Prospective Studies; D012074:Remission Induction
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D004337:Drug Carriers; D009944:Organoplatinum Compounds; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin