Our doctors may recommend that you undergo chemotherapy or biologic therapy in addition to (or in place of) surgery to control your cancer. These approaches might be used alone or in combination.
The availability of more-effective chemotherapy drugs in recent years has significantly helped to improve survival rates for people with liver metastases.
Our medical oncologists use chemotherapy to reduce the risk that tumors will come back (recur) following surgery and to shrink liver metastases from the colon and rectum that cannot be safely removed with surgery.
Medical oncologist Nancy Kemeny reviews evidence for HAI in extending survival and improving quality of life for patients with colorectal cancer and liver metastases.
Delivery through Hepatic Arterial Infusion (HAI)
Patients typically receive chemotherapy systemically (throughout the body) through intravenous infusion. At Memorial Sloan Kettering, when the cancer is completely confined to the liver only, we also offer the option to have chemotherapy delivered directly to the affected region through a procedure called hepatic arterial infusion (HAI).
HAI delivers a high dose of chemotherapy into the hepatic artery — the main source of blood and nutrients for liver tumors — through a tiny pump implanted under the skin in the lower abdomen. The pump can be filled with additional chemotherapy as needed.
Our doctors have significant experience with HAI chemotherapy. This approach may prolong survival for some patients following surgery, and because the chemotherapy is delivered directly to the tumor site, it also may cause fewer side effects than systemic chemotherapy and give you a better quality of life.
In some people who cannot have liver metastases removed because of their number, size, or location, systemic chemotherapy or HAI plus systemic chemotherapy may reduce tumors enough that surgical removal becomes possible.
Our researchers are constantly evaluating new chemotherapy combinations that may improve the standard of care for people with liver metastases. These investigational therapies are sometimes offered to eligible patients through our clinical trials.
Unlike chemotherapy drugs, which kill cancer cells as well as healthy cells, biologic drugs provide a more targeted approach. They stop tumor cells from replicating (copying themselves) and/or disrupt a tumor's blood supply. Doctors use them in combination with various chemotherapy drugs to improve the effectiveness of treatment.
Biologic drugs commonly recommended for people with liver metastases include:
- Anti-angiogenesis drugs. These drugs stop the growth of blood vessels that nourish tumors. They may be given with chemotherapy before or after surgery.
- Epidermal growth factor receptor (EGFR) inhibitors. These drugs block a protein, called epidermal growth factor receptor, that may contribute to the progression of colorectal cancer. Before treating you with one of these drugs, your doctor will test you for a mutation in a gene called KRAS. EGFR drugs are not effective in patients with this mutation. Clinical studies are under way to evaluate drugs that may be effective in treating these patients.