intra-arterial hepatic bevacizumab and systemic chemotherapy

Conditions: Colorectal Neoplasms

Summary: the purpose of the study is to assessed the efficiency of treatment based on the objective response rate (recist 1.1)


Eligibility criteria:
inclusion criteria: * liver metastases of colon cancer or rectal predominant (histological evidence obtained on the primary tumor or liver metastases) * isolated (no extra-hepatic metastasis, primary tumor resected) * no access to curative hepatectomy (r0 resection foreseeable or not leaving less than 30% residual non-tumor liver normally vascularized), or requiring complex hepatectomy, very large (5 or more segments) and / or risked (class ii cpp) * which at least one measurable by recist (\>2 cm, or \>1 cm if computed tomography (ct) spiraled) * or extra-hepatic disease of small size potentially accessible to a resection (one or two lung metastases, lymphadenopathy localized accessible to curative resection) * colon or rectal primary tumor : resected or asymptomatic * progression after first line chemotherapy to treat the metastatic disease, all types of treatment allowed except intra-arterial bevacizumab * age \>18 years \<75 years * performance status who 0 or 1 * life expectancy \>3 months * bilirubin \ 1.5 x 10\^9/l, platelets ≥100 x 10\^9/l, hemoglobin \>9g/dl. patients may be included even if they were transfused * ct (or mri) reference for the measurement of metastases performed within 28 days before the first treatment cycle * information of the patient or legal representative signing the informed consent * affiliated to a social security system exclusion criteria: * symptomatic colon or rectal primary tumor (sub-occlusion, significant hemorrhage, major rectal syndrome) * extra-hepatic metastases other than small size disease potentially accessible after resection * grade 3-4 allergy to one of the treatment compounds * two lines of prior chemotherapy. one line is allowed for metastatic disease but must have been started more than 6 months after completion of adjuvant treatment. * participation during or within 30 days before study to another therapeutic trial with an experimental molecule * concomitant cancer systemic treatment using immunotherapy, chemotherapy or hormone * symptomatic chd or myocardial infarction within 6 months prior entry into the study, cardiac arrhythmia uncontrolled despite treatment * uncontrolled hypertension (blood pressure \>150/100 mm hg despite hypertensive treatment) * heart failure \>grade ii of the new york heart association (nyha) (class ii-iii-iv)severe renal failure * history and / or presence of bleeding disorders and/or thrombotic \<6 months * uncontrolled serious illness, uncontrolled active infection or other serious underlying condition which may prevent the patient to receive treatment * pregnancy (or positive pregnancy test at baseline), lactation or no contraception effective for men or women of childbearing age * occlusion or sub-bowel obstruction or history of inflammatory bowel disease * other cancer within 5 years prior to entry into the trial or concomitant (except in situ cancer of the cervix or skin basal-cell carcinoma properly treated) * legal inability (persons deprived of liberty or under guardianship) * inability to sign the consent or submit to medical test for geographical, social or psychological reasons.