Help for sister with multiple liver mets

[Janelle]

Hi Friends,
I have a close friend who is 36 years old and HER2 negative so she doesn't post on this board. She was diagnosed in January of 2007 and found out in February that she has multiple liver mets.

Her bilirubin count is good so far as is her kidney function. The mets are confined to her liver.

She previously was treated with A/C + taxol and avastin when she was diagnosed. She was originally diagnosed at Stage 2 (a). She is not on Carbo and Gezmar and it is not working.

Any advice for possible alternative treatments? Has anyone heard of Laser-induced Interstitial Thermotherapy? Any other ideas?

Has anyone had chemoemobolization to the liver?

I would love your input on who you think are the best medical oncologists in the country or liver specialist for treating a young breast cancer survivor with mets to the liver. Thank you so much!!!!

Please feel free to email me at jpauer@kramerlevin.com or post here.

Janelle

[Rich66]

See recent posts on liver mets.
Not sure if LITT is in the US. Here is an article on a variation to improve results:
1: Eur J Surg Oncol. 2007 Jun;33(5):608-15. Epub 2007 Apr 2. Links
Improving laser-induced thermotherapy of liver metastases--effects of arterial microembolization and complete blood flow occlusion.

Ritz JP, Lehmann KS, Zurbuchen U, Wacker F, Brehm F, Isbert C, Germer CT, Buhr HJ, Holmer C.
Department of General, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
INTRODUCTION: A prerequisite for an oncologically curative application of laser-induced thermotherapy (LITT) of liver metastases is complete tumor destruction. This increased effectiveness was achieved experimentally by combining LITT with interrupted hepatic perfusion. The aim of this study was to evaluate whether an interventional selective arterial microembolization might be as effective as complete blood flow occlusion using an open Pringle's maneuver. PATIENTS AND METHODS: We included patients with unresectable colorectal liver metastases. LITT was performed without interrupted hepatic perfusion (control group) compared to LITT in combination with interrupted perfusion either by embolization of intraarterial degradable starch microspheres (DSM) (percutaneous access) or by complete hepatic inflow occlusion (Pringle's maneuver; open access). Online monitoring was performed using intraoperative ultrasound or MRI. Volumetric techniques were used to assess metastases and postinterventional lesions. RESULTS: Fifty-six patients with 104 metastases (control group (25), DSM (37), and Pringle (42)) were treated. The preinterventional tumor volumes were significantly smaller than the postinterventional lesion volumes (control group: 9.8 vs. 25.3 cm3; DSM: 9.5 vs. 65.4 cm3; Pringle: 12.9 vs. 76.5 cm3). The morbidity rate was 21.4% without treatment-related mortalities. After 6 months follow-up, tumor recurrence was diagnosed in 6 patients (control group (4), LITT with DSM (1), and Pringle (1)). CONCLUSIONS: Combining LITT with blood flow occlusion leads to a significant increase in lesion size. The application of DSM offers a safe and effective alternative to the open access with Pringle's maneuver. Compared to LITT-monotherapy, this modality achieves significantly larger thermal lesions with the need of fewer applications.
PMID: 17400421 [PubMed - indexed for MEDLINE

[Janelle]

Thanks, Rich!

[Sheila]

Janelle
I have a friend who is also Her2 Neg, and was diagnosed with extensive liver mets at original diagnosis. She was in a trial at Loyola in Chicago and on Abraxane, Avastin and Carbo...she had progression on it and is now on Doxil and something else...i will find out...she is doing quite well and the mets are shrinking away. She sees Dr Albain at Loyola.

[Joan M]

Janelle,

I had a lung RFA and your friend might want to find out whether this might be an option. It would depend on the number of mets and the size of them. Sometimes they can be partially ablated or the small ones can be ablated, which would help reduce the tumor load for further chemotherapy. Since I had a lung RFA I don't know the details and your friend would have to look into the option.

Joan

[Lori R]

Janelle,
This must be the week for Liver Mets (next year we'll remove this week from the calendar).

I was just diagnosed with a recurrance of a single met in the liver and have an appointment on Tuesday with an interventional radiologist to learn more about RFA. At the moment, my met is a single met (at least that's all that showed on the current scan)

I will certainly ask him about whether RFA is a good option for multiple mets, can it be used again and again, what are the risks...limitations etc.? I'll post the answers next week after my meeting.

I am encouraged by RFA as I just want these wild and crazy cells blasted away quickly. Then chemo can do the clean up work.

I wish I had an immediate answer for you but will post when I know more.

So many options out there...we just need to keep pushing the envelope of new technology and be smart about how to best use it!!!

Sending comforting thoughts....Lori

[Janelle]

Thank you all so much for your input. You all are amazing!