Floxuridine and Dexamethasone as a Hepatic Arterial Infusion and Bevacizumab in Treating Patients With Primary Liver Cancer That Cannot be Removed by Surgery

This is an interventional treatment trial for Liver Cancer focused on measuring adult primary hepatocellular carcinoma, localized unresectable adult primary liver cancer, advanced adult primary liver cancer, recurrent adult primary liver cancer, adult primary cholangiocellular carcinoma Read More

DISEASE CHARACTERISTICS:

• Histologically confirmed hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC)

  • Peripheral, cholangiolar, or cholangiocellular types
  • Mixed HCC/ICC disease allowed
  • Unresectable disease
  • Less than 70% liver involvement
• Radiographically bidimensionally measurable disease, defined as lesion ≥ 2 cm in the greatest diameter
• May have failed prior systemic chemotherapy or ablative therapy
• No radiographic evidence of esophageal varices
• No history of variceal hemorrhage
• No occlusion of the main portal vein or the right and left portal branches
• No clinical ascites
• Patients ineligible for first-line MSKCC protocols for HCC are eligible for this study provided there is no clinical or radiographic evidence of extrahepatic disease
• No metastatic disease, including CNS metastases

PATIENT CHARACTERISTICS:

• Life expectancy ≥ 12 weeks
• Karnofsky performance status 60-100%
• Considered a candidate for general anesthesia and hepatic artery pump placement
• Platelet count > 100,000/mm³
• Albumin > 2.5 g/dL
• Bilirubin < 1.8 mg/dL
• WBC > 3,500/mm³
• PTT < 1.5 times upper limit of normal
• INR < 1.5 OR in-range INR (usually 2.0-3.0) for patients on a stable dose of therapeutic warfarin

• Urine protein < 1+ by dipstick or urine analysis OR urine protein:creatinine ratio < 1.0

  • If proteinuria ≥ 2+ at baseline, patient must have < 1 g protein/24-hour collection

• No concurrent disease or illness that would preclude study participation, including any of the following:

  • Hepatic encephalopathy
  • Sclerosing cholangitis
  • Gilbert's disease
  • Active infection
• No known CNS disease
• No history of allergic reactions attributed to compounds of similar chemical or biologic composition to bevacizumab
• No psychiatric illness or social situation that would preclude study compliance
• No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
• No serious or nonhealing active wound, ulcer, or bone fracture
• No bleeding diathesis or coagulopathy

• No clinically significant cardiovascular disease, including any of the following:

  • Uncontrolled hypertension, defined as systolic blood pressure (BP) > 150 mm Hg or diastolic BP > 100 mm Hg on antihypertensive medications
  • New York Heart Association class II-IV congestive heart failure
  • Vascular disease (e.g., aortic aneurysm, aortic dissection)
  • Myocardial infarction within the past 6 months
  • Symptomatic peripheral vascular disease
  • Unstable angina within the past 6 months
  • History of hypertensive crisis
  • Transient ischemic attack
  • Stroke
• No other concurrent malignancy except localized basal cell or squamous cell skin cancer
• Chronic hepatitis and/or cirrhosis allowed provided it is Child-Pugh class A disease
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• More than 4 weeks since prior and no other concurrent experimental therapy except on a Genentech-sponsored bevacizumab cancer study
• More than 4 weeks since prior major surgical procedure or open biopsy
• More than 1 week since prior minor surgical procedure (e.g., core biopsy), excluding placement of a vascular access device
• No prior external-beam radiation therapy to the liver
• No prior floxuridine
• No chronic daily treatment with nonsteroidal anti-inflammatory medications known to inhibit platelet function
• No chronic daily treatment with aspirin (> 325 mg/day)
• No concurrent or recent use of a thrombolytic agent
• No concurrent major surgery