What is Already Known About This Subject?Hepatic arterial infusion (HAI) pumps represent 1 promising treatment strategy for patients presenting with liver only or predominant tumors. HAI therapy is a form of locoregional therapy which administers chemotherapy directly into the hepatic artery, thus limits systemic exposure and spares other organs from toxicity. According to the National Comprehensive Cancer Network Guidelines (NCCN), placement of a HAI pump, in combination with systemic chemotherapy, has a category 2B recommendation for centers with the requisite expertise to perform this procedure. However, the utility of HAI pumps for patients with previously treated relapsed/refractory colorectal cancer (CRC) with colorectal liver metastases (CRLM) remains unclear.

What are the New Findings?Here, we describe a case of heavily pretreated patient with CRC and CRLM unusually responsive to HAI chemotherapy. Our patient had a progression free survival (PFS) of 20.2 months with HAI therapy, versus a PFS of 3 to 6 months with systemic chemotherapy therapy. Furthermore, in this case, the patient has been able to stay off systemic therapy for over a year by the time of this publication. Based on the patient's response, HAI therapy may slow the rate of disease progression compared to other therapies, as it might “reset the clock” as it did for this patient's very aggressive biology.

How Might it Impact on Clinical Practice in the Foreseeable Future?We believe this to be the first published case report of a patient with previously treated HER2+ CRC who had progressed on anti-HER2 therapy, who had a substantial response from treatment with FUDR HAI chemotherapy. Our report adds to the dearth of the literature in this patient population, and supports use of HAI chemotherapy as a potential treatment strategy for patients with relapsed, refractory CRLM. This case suggests that HAI chemotherapy with FUDR in combination with systemic therapy has the potential to provide long-term responses even for patients with CRLM refractory to multiple lines of chemotherapy.

关于这个主题已经知道了什么？肝动脉输注 (HAI) 泵代表了一种针对仅患有肝脏肿瘤或主要肿瘤的患者的一种有前景的治疗策略。HAI疗法是一种局部治疗形式，将化疗直接注入肝动脉，从而限制全身暴露并使其他器官免受毒性。根据美国国家综合癌症网络指南 (NCCN)，对于具备执行该手术所需专业知识的中心，将 HAI 泵与全身化疗相结合的放置方式列为 2B 类建议。然而，HAI 泵对于既往接受过治疗的复发/难治性结直肠癌 (CRC) 伴结直肠肝转移 (CRLM) 患者的效用仍不清楚。

有哪些新发现？在这里，我们描述了一个接受过大量治疗的 CRC 和 CRLM 患者对 HAI 化疗异常敏感的病例。我们的患者接受 HAI 治疗后的无进展生存期(PFS) 为 20.2 个月，而全身化疗治疗的 PFS 为 3 至 6 个月。此外，在本例中，截至本文发表时，患者已经能够停止全身治疗一年多了。根据患者的反应，与其他疗法相比，HAI 疗法可能会减缓疾病进展的速度，因为它可能会“重置时钟”，就像针对该患者非常具有攻击性的生物学行为一样。

在可预见的未来，它会对临床实践产生什么影响？我们相信这是第一份发表的病例报告，涉及既往接受过治疗的 HER2+ CRC 患者，该患者在接受抗 HER2 治疗后病情出现进展，并且对 FUDR HAI 化疗有显着反应。我们的报告补充了该患者群体文献的匮乏，并支持使用 HAI 化疗作为复发、难治性 CRLM 患者的潜在治疗策略。该病例表明，HAI 化疗联合 FUDR 与全身治疗相结合，即使对于多线化疗难治的 CRLM 患者也有可能提供长期缓解。