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October 1, 2014

New chemotherapy approaches offering increased survival rates

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L to R: Daniel M Libby, MD, Nancy Kemeny’s husband, Professor of Medicine at Weill Cornell Medical Center and Attending Physician at New York Presbyterian Hospital; Prof Nancy E Kemeny; and Dr Derek Power, Consultant Medical Oncologist, Mercy University Hospital, Cork

In the treatment of patients with colorectal cancer, liver metastases (secondaries) are a common clinical challenge. If patients can undergo surgical removal of the liver metastases, long-term survival can be achieved.

However, moving a patient from inoperable liver disease to operable disease remains a major challenge, and the majority of patients who successfully undergo liver resection for colorectal metastases will have reoccurrence of their disease. Therefore, additional treatments before and after liver resection are urgently needed.

Prof Nancy Kemeny, Attending Medical Oncologist at the Memorial Sloan-Kettering Cancer Centre in New York, was in Cork recently to present her work on the use of regional chemotherapy to improve survival rates for patients with liver metastases due to colorectal cancer.

Prof Kemeny was presenting a lecture entitled ‘State of the Art in Hepatic Arterial Infusion in Liver Resection’ at the annual Southern Symposium on Foregut Cancers, held in UCC.

During her 35 years at Memorial Sloan-Kettering, Prof Kemeny has conducted some of the first studies using drugs such as irinotecan and oxaliplatin, which are now widely used in patients with colorectal cancer. She was also the lead investigator of a large, multi-institutional study that helped in the Food and Drug Administration’s approval of oxaliplatin for colorectal cancer treatment in the US.

Hepatic arterial infusion is a regional chemotherapy, which involves administering drugs into an artery that feeds tumours in the liver. This can be done using an internally-implanted pump.

Dr Kemeny has shown the effectiveness of regional chemotherapy given in combination with systemic chemotherapy and this has led to its use in patients who are being considered for surgical removal of liver metastases. This combination therapy has also decreased the recurrence of disease after liver resection.

Recent new studies using this therapy have allowed patients with extensive liver disease, who are not eligible for surgery, to achieve an excellent response, which then allows resection of the disease.

Prof Kemeny and her colleagues have also used this treatment for patients with primary liver cancer.

The Attending Medical Oncologist at Memorial Sloan Kettering focuses on the treatment of hepatic metastases, since 60 per cent of patients with advanced cancers have liver metastases. For many years, she used hepatic arterial infusion (HAI) of chemotherapy to increase response and survival. “Initially, we showed that HAI produced better results than systemic chemotherapy, and now, using a combination of HAI plus modern systemic chemotherapy, we have produced response rates greater than 80 per cent in patients with diffuse unread table liver metastases,” she explained.

More recently, Prof Kemeny and her colleagues have used HAI and systemic chemotherapy after liver resection, which has yielded five-year survivals greater than 70 per cent in two trials, published in high-impact scientific journals.

In addition to Prof Kemeny’s clinical and research responsibilities at Memorial Sloan-Kettering, she is a Professor of Medicine at Weill Cornell Medical College. She is also active in oncology issues on a national level. In 1990, she served as a member of the Oncology Drug Advisory Committee, and has held various high-level positions at the American Society of Clinical Oncology (ASCO).

Dr Derek Power, Consultant Oncologist at Cork University and Mercy Uni-versity Hospitals, said the meeting organisers were “thrilled” to have Prof Kemeny there to share her latest results with cancer clinicians in Ireland. “We urgently need new treatment options for liver metastases due to colon cancer and Prof Kemeny’s new chemotherapy regimes are showing wonderful results. We are excited to be bringing these new approaches and techniques to Cork so that we can offer the most-up-to-the-minute treatments for Irish patients.”

Mr Criostóir O’Súilleabháin of the Mercy University Hospital, the lead liver surgeon in Cork and the organiser of the conference, added that the addition of HAI therapy would allow more patients to undergo liver surgery for advanced colorectal cancer that had spread to the liver.

“Prof Kemeny’s published work suggests that overall survival is improved by this strategy,” he said.

Prof Kemeny said she has been fortunate to come to know many wonderful Irish medical oncologists who have come to Memorial Sloan Kettering Cancer Center for part of their early career training, including Drs Derek Power and Gregory Leonard. “It is great to be working again with Derek and with the liver surgeons in Cork to share our new approaches and techniques. I look forward to welcoming them to New York to foster collaboration between our institutions,” she added.