Colorectal cancer is one of the hardest cancers to detect. That is why treatment is often given when the disease has already advanced. The local abdominal administration of a chemotherapy drug combined with blood-infused chemotherapy has shown promising results in fighting colorectal cancer in advanced stages.
The management of patients with colorectal cancer remains a major healthcare challenge as this malignancy is the third most common cancer globally and the second most frequent cancer-related cause of death in Europe after lung cancer.
Colorectal cancer frequently metastasises in the peritoneum, which is the serous membrane that forms the lining of the abdominal cavity. The name for this condition is called “peritoneal carcinomatosis”. A patient has a better prognosis if the resection of the tumours is possible. For initially inoperable patients, solutions need to be found so that the metastases become operable.
One of the potential solutions is the intensification of the systemic treatment with the local administration of chemotherapeutic agents such as Oxaliplatin. Systemic treatment reaches cells throughout the body by travelling through the bloodstream. Oxaliplatin is a good candidate for local (intraperitoneal) administration and has largely proven effective in this disease.
In a pilot study, published in Pleura and Peritoneum, the feasibility of a treatment associating systemic chemotherapy with intraperitoneal oxaliplatin was tested on six patients with a highly evolved peritoneal disease. The intraperitoneal administration of oxaliplatin combined with systemic treatment was well tolerated with very few high grade toxicities. Abdominal pain and fatigue were more often encountered as side effects from the treatment, but an adapted analgesia (tailored application of pain relief) can be useful. Other toxicities seemed related rather to the systemic chemotherapy treatment consisting of FOLFIRI or LV5FU2 than to Oxaliplatin.
The study’s findings justify the development of a phase I trial in order to provide the basis of a new treatment in this clinical setting.
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Olivia Sgarbura, Emmanuelle Samalin, Sébastien Carrere, Thibault Mazard, Hélène de Forges, Mathias Alline, Marie-Hélène Pissas, Fabienne Portales, Marc Ychou, François Quenet: Preoperative intraperitoneal oxaliplatin for unresectable peritoneal carcinomatosis of colorectal origin: a pilot study, 21.12.2016