Hepatic Arterial Infusion of Liposomal Irinotecan Plus Oxaliplatin and Capecitabine as Adjuvant Therapy for Colorectal Cancer Liver Metastases

Colorectal cancer commonly metastasizes to the liver, and recurrence after radical resection of colorectal cancer liver metastases remains frequent, particularly in the liver. Systemic adjuvant chemotherapy is commonly used after resection to eliminate potential micrometastatic disease; however, systemic chemotherapy may have limited local efficacy in the liver and may be associated with systemic toxicity.

Hepatic arterial infusion chemotherapy delivers chemotherapy directly into the hepatic arterial supply. Because liver tumors are mainly supplied by the hepatic artery, this approach may increase local drug concentration in the liver while reducing systemic exposure. Liposomal irinotecan is a liposomal formulation of irinotecan designed to improve drug stability, prolong circulation, enhance tumor accumulation, and potentially reduce systemic toxicity.

This study will explore whether hepatic arterial infusion of liposomal irinotecan combined with systemic oxaliplatin and capecitabine can improve disease-free survival and hepatic recurrence-free survival while maintaining an acceptable safety profile in patients at high risk of hepatic recurrence after radical resection of colorectal cancer liver metastases.

Inclusion criteria

• Age 18 to 75 years.
• Completion of radical resection of the colorectal primary tumor and liver metastases within 12 weeks before enrollment, with postoperative imaging showing no residual lesion, recurrence, or extrahepatic metastasis, indicating no evidence of disease.
• Histologically confirmed colorectal cancer liver metastases.
• ECOG performance status of 0 or 1.
• Expected survival of at least 3 months.
• Clinical risk score of 3 or higher.
• Adequate bone marrow function, defined as absolute neutrophil count >2 × 10^9/L, hemoglobin >9.0 g/dL, and platelet count >100 × 10^9/L.
• Adequate renal function, defined as serum creatinine ≤1.5 × the upper limit of normal or creatinine clearance ≥30 mL/min according to the Cockcroft-Gault formula.
• Adequate hepatic function, defined as serum bilirubin ≤1.5 × the upper limit of normal, transaminases ≤2.5 × the upper limit of normal or ≤5 × the upper limit of normal if liver metastasis is present, and alkaline phosphatase ≤5 × the upper limit of normal.
• Female participants must not be pregnant or breastfeeding. Women of childbearing potential and male participants must use effective contraception during the study and for 6 months after completion of study treatment.
• Good compliance, ability to understand the study procedures, and willingness to sign written informed consent.

Exclusion criteria

• Contraindication to capecitabine, oxaliplatin, or irinotecan.
• Any history of hepatic interventional therapy, including transarterial infusion, hepatic arterial infusion, or transarterial chemoembolization.
• Receipt of adjuvant chemotherapy containing irinotecan after resection of the primary tumor, or receipt of adjuvant therapy without irinotecan with the last dose administered within 3 months before enrollment.
• Dihydropyrimidine dehydrogenase deficiency.
• History of severe cardiovascular disease resulting in inability to tolerate treatment.
• Peripheral neuropathy greater than Grade 1.
• History of another malignancy within the previous 5 years, except cured carcinoma in situ or basal cell carcinoma of the skin.
• History of allogeneic organ transplantation.
• Requirement for renal dialysis.
• Breastfeeding, pregnancy, or inadequate contraception in women of childbearing potential.
• Uncontrolled concomitant disease, including but not limited to severe active or uncontrolled infection, symptomatic congestive heart failure, unstable angina, arrhythmia, uncontrolled diabetes, or psychiatric illness that may affect study compliance.
• Participation in another clinical trial currently or within 4 weeks before enrollment.
• Any condition that, in the investigator's judgment, makes the participant unsuitable for the study.