P91. A Novel Phase II Trial of Hepatic Arterial Infusional Floxuridine With Systemic Chemotherapy in the Treatment of Pancreatic Cancer Liver Metastases

Saturday, March 7, 2026

8:46 AM - 8:53 AM MST

Location: 105A-C

Primary Author(s)

GW

G. Paul Wright, MD, FACS, FSSO

Assistant Professor of Surgery
Michigan State University/Corewell Health West Cancer Center
Grand Rapids, Michigan, United States

Slides

Co-Author(s)

JA

Jason M. Aubrey, MD

Resident
Michigan State University/Corewell Health West Cancer Center
Grand Rapids, Michigan, United States
RP

Randa L. Preihs, NP (she/her/hers)

Advanced Practice Provider
Corewell Health West Cancer Center
Grand Rapids, Michigan, United States
AB

Alexandra Bengel, PA-C

Advanced Practice Provider
Corewell Health West Cancer Center
Grand Rapids, Michigan, United States
CK

Chantelle Koch, PA-C

Advanced Practice Provider
Corewell Health West Cancer Center
Grand Rapids, Michigan, United States
LM

Lisa Martin, PA-C

Advanced Practice Provider
Corewell Health West Cancer Center
Grand Rapids, Michigan, United States
SC

Sreenivasa Chandana, MD

Attending Physician
Cancer and Hematology Centers of West Michigan
Grand Rapids, Michigan, United States
MA

Mura Assifi, MD, FACS

Clinical Professor of Surgery
Michigan State University/Corewell Health West Cancer Center
Grand Rapids, Michigan, United States
MC

Mathew H. Chung, MD, FACS (he/him/his)

Professor of Surgery
Michigan State University/Corewell Health West Cancer Center
Grand Rapids, Michigan, United States

Primary Presenter(s)

GW

G. Paul Wright, MD, FACS, FSSO

Assistant Professor of Surgery
Michigan State University/Corewell Health West Cancer Center
Grand Rapids, Michigan, United States

Slides

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer. Best available systemic chemotherapy offers survival < 12 months for metastatic disease. We performed a proof-of-concept pilot study to evaluate hepatic arterial infusion pump (HAIP) chemotherapy in patients with PDAC liver metastasis.

Methods: Patients with synchronous, liver-dominant metastatic PDAC were recruited from 2019-2024. Patients were required to exhibit stable disease or partial response after at least two months of systemic chemotherapy. Diagnostic laparoscopy was performed on all to rule out peritoneal disease. Enrolled patients underwent open HAIP placement and were offered concurrent resection or irreversible electroporation (IRE) of the primary tumor. Floxuridine was delivered in 28-day cycles at 0.12 mg/kg/day for up to six cycles with systemic chemotherapy. The primary outcome measure was 1-year hepatic progression-free survival (PFS) with secondary outcomes including quality of life and overall survival (OS). A pre-defined clinically significant improvement from 14% to 40% 1-year hepatic PFS was used with a = 0.1 and power of 80% to obtain a sample size of 14 patients.

Results: Fourteen patients were enrolled with median age of 66 (range 49-79) and 10 were male (71.4%). Seven patients (50%) underwent distal pancreatectomy, two pancreaticoduodenectomy (14.3%), three IRE (21.4%), and two declined intervention. Postoperative pancreatic fistula occurred in 4/9 surgical patients (44.4%). Median cycles of floxuridine received was 4 (range 1-6). Eight patients (57%) demonstrated 1-year hepatic PFS, meeting the primary endpoint. Median hepatic PFS was 15 months (95% CI 13.5-16.6) (Figure 1). Of the six patients who did not achieve 1-year hepatic PFS, four did not exhibit hepatic progression at last follow-up. One patient died at 6 months from presumed cardiac event. Another had progressive dementia, declined follow-up imaging beyond 9 months, and died at 13 months. Two patients had peritoneal recurrence and died of disease at 11 months with no hepatic progression. Median OS was 13 months (95% CI 6.9–19.1), while 5/14 (35.7%) achieved 2-year OS. Global health status QOL did not differ between baseline and 6-month assessments (153±32 vs. 157±47, p=0.72).

Conclusions: In this novel clinical trial, HAIP chemotherapy showed promising disease control in the liver when administered with systemic therapy. While this represents a highly-selected patient population, further study of HAIP chemotherapy in the treatment of PDAC liver metastases is warranted.

Learning Objectives:

Understand the baseline median survival for patients with metastatic pancreatic ductal adenocarcinoma with systemic chemotherapy alone.
Describe complications associated with hepatic arterial infusion pump placement in combination with primary tumor resection.
Evaluate options for future study of regional therapy in the treatment of pancreatic cancer liver metastasis.