A Phase II Study of Yttrium-90 Radioactive Resin Microspheres in the Treatment of Colorectal Adenocarcinoma Metastatic to the Liver After Failure of First-Line Combination Chemotherapy

Inclusion Criteria:

- Histologically confirmed colorectal carcinoma. Liver metastasis will be confirmed by
either PET scan or biopsy.

- Ability to understand and willingness to sign written informed consent

- Minimum of 18 years of age

- Liver dominant metastases measurable by CT or MRI and therefore amenable to serial
assessment using RECIST criteria

- Progressive disease of metastatic colorectal carcinoma on first line combination
chemotherapy with a FOLFOX based regimen (Folinic Acid, Oxaliplatin and
Fluorouracil)or failure of first line chemotherapy due to toxicity

- Candidate for second line chemotherapy with a FOLFIRI regimen (Folinic Acid,
Fluorouracil & Irinotecan). Per standard of care, second line chemotherapy will not
include Bevacizumab.

- Karnofsky Performance Score (KPS) of 70% or greater

- Life expectancy of greater than or equal to four months by investigator estimation

- Females with negative urine or serum pregnancy test

- Effective double barrier contraception for a minimum of two months following the
final infusion of microspheres

- Patients who are not candidates for transarterial chemoembolization (TACE), thermal
ablation or surgical resection

Exclusion Criteria:

- Dominant extra-hepatic disease including cerebral metastases or other extra-hepatic
metastases that are symptomatic

- Large volume ascites assessed by cross sectional CT imaging

- Any chemotherapy < 4 weeks prior to the first microsphere treatment

- Anticipated to need Avastin chemotherapy within eight weeks of day M1

- Absolute neutrophil count (ANC) < 1.5 x 109/L

- Platelets (PLT) < 60,000/mm3

- Hemoglobin (Hgb) < 9.0 gm/dL

- Prothrombin time (PT) or Partial Prothrombin time (PTT) > upper limit of normal (ULN)

- Serum Creatinine > 2.0 mg/dL

- Forced expiratory volume (FEV1) < 1L by baseline pulmonary function tests (ordered if
investigator judges it to be clinically indicated)

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 5 times upper
limits of normal (ULN) or total bilirubin > 2.0 mg/dL

- History of incompetent sphincter of oddi (e.g.: sphincterotomy, biliary-enteric
anastamosis, or percutaneous biliary drain)

- Severe hypoalbuminemia (albumin < 2.0 g/dL)

- Alkaline phosphatase > 2.5 times ULN

- Greater than 20% lung shunting (determined by the MAA - Tc 99 nuclear medicine lung
shunt scan)

- Pre assessment angiogram and MAA scan demonstrating any uncorrectable activity in the
stomach, bowel or pancreas

- Major surgery < 4 weeks prior to the first microsphere treatment

- Female who is pregnant or nursing

- Men and women of childbearing potential wishing to conceive < 2 months following the
completion of the microsphere portion of the study.

- Any investigational agent administered < 4 weeks prior to microsphere treatment

- A known history of hepatitis B or hepatitis C

- Known hypersensitivity to any component of microsphere infusion

- History of, or current coagulation or bleeding disorder

- History of significant hepatic cirrhosis, fibrosis or hemochromatosis

- History of malignancy, other than colorectal cancer, within five years of the start
of study participation, except in situ cervical or skin cancer

- Active severe infection or any other concurrent disease or medical conditions that
are likely to interfere with the study as judged by the investigator

- Prior treatment with radioactive microspheres or external beam radiation therapy to
the liver

- Prophylactic anticoagulation and nonsteroidal antiplatelet drugs are only a
contraindication, if the PT/PTT are above the ULN. Plavix (clopidogrel) will need to
be stopped 5 days prior to the hepatic-angiogram and the microsphere procedures, then
started the next day.

- History of right to left, bi-directional or transient right to left cardiac shunts,
worsening or clinically unstable congestive heart failure, acute myocardial
infarction or acute coronary syndromes serious ventricular arrhythmias or high risk
for arrhythmias due to prolongation of the QT interval, respiratory failure as
manifested by signs or symptoms of carbon dioxide retention or hypoxemia or severe
emphysema, pulmonary emboli or other conditions that causes pulmonary hypertension
due to compromised pulmonary arterial vasculature