Outcomes Following Treatment with FOLFOX for Patients with Resectable or Potentially Resectable Metastatic Colorectal Cancer: A Population-based Cohort Study

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 35; no. 3; pp. 188 - 198
• Main Authors: Habbous, S., Tai, X., Gill, T., Arias, J., Beca, J., Raphael, M.J., Kennedy, E., Biagi, J.J., Chan, K.K.W.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2023
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cohort Studies; Colonic Neoplasms - drug therapy; Colorectal cancer; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - surgery; FOLFOX; Humans; liver metastasis; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Liver Neoplasms - surgery; lung metastasis; Lung Neoplasms - drug therapy; Lung Neoplasms - surgery; Ontario; oxaliplatin; Oxaliplatin - therapeutic use; Rectal Neoplasms - drug therapy; Retrospective Studies; Ontario; oxaliplatin; liver metastasis; lung metastasis; FOLFOX; Colorectal cancer
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2022.12.009

To evaluate the safety and effectiveness of oxaliplatin-based combination chemotherapy for patients with metastatic colorectal cancer (mCRC) to extrahepatic sites.
We conducted a population-based retrospective study examining the safety and effectiveness of perioperative oxaliplatin for resectable or potentially resectable colorectal metastases in Ontario, Canada. Outcomes were also compared with patients with liver-only metastases. Patients received oxaliplatin for mCRC between 1 January 2013 and 30 June 2020.
In total, 192 patients had extrahepatic metastases. Seventy per cent had R0 metastasectomy. The 3-year disease-free survival and overall survival were 62% and 79%, respectively; <4% of patients died within 60 days of metastasectomy and 74–90% of patients received treatment according to recommendations from a multidisciplinary setting. Compared with liver-only controls (n = 1306), patients had mCRC to the lung only (n = 115), lung and liver (n = 55) and liver with non-pulmonary site (n = 22). Extrahepatic metastases were more likely to be found for patients whose primary colorectal resection had positive margins (14% versus 7%, P = 0.005) and primary tumours located in the rectum [odds ratio 4.01 (2.31–6.97)]. After adjustment, there was no difference in overall survival between liver-only controls and patients with lung-only [hazard ratio 0.82 (0.59–1.15)] or liver and lung metastases [hazard ratio 1.26 (0.85–1.87)] (P = 0.24). In total, 79/115 (69%) of patients with lung-only metastases had a metastasectomy compared with 645/1306 (49%) and 15/55 (27%) of patients with liver-only and liver and lung metastases, respectively. Hospital visits were similar between patients with liver-only and extrahepatic metastases.
Oxaliplatin-based chemotherapy for patients with resectable or potentially resectable mCRC with extrahepatic metastases was safe and resulted in similar outcomes in appropriately selected patients when compared with patients with liver-only metastases.
•The lung is the second most common site of colorectal cancer metastases apart from the liver.•Perioperative FOLFOX is safe in selected patients with (potentially) resectable colorectal metastases to the lung.•Survival was similar following perioperative FOLFOX for colorectal metastases to the liver, lung, and liver and lung.