Pre-operative chemotherapy for colorectal cancer liver metastases: an update of recent clinical trials

• Published in: Cancer chemotherapy and pharmacology Vol. 66; no. 2; pp. 209 - 218
• Main Authors: Nasti, G, Ottaiano, A, Berretta, M, Delrio, P, Izzo, F, Cassata, A, Romano, C, Facchini, G, Scala, D, Mastro, A, Romano, G, Perri, F, Iaffaioli, R. V
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01-07-2010; Springer-Verlag; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Antineoplastic agents; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Cancer Research; Chemotherapy, Adjuvant; Clinical Trials as Topic; Colorectal cancer; colorectal neoplasms; Colorectal Neoplasms - pathology; Combined Modality Therapy; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver metastases; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Medicine; Medicine & Public Health; Mini Review; Neoadjuvant; Oncology; Pharmacology. Drug treatments; Pharmacology/Toxicology; Preoperative Care; Prospective Studies; resection; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Neoadjuvant; Liver metastases; Resection; Colorectal cancer; Human; Rectal disease; Hepatic disease; Surgical resection; Malignant tumor; Neoadjuvant treatment; Colonic disease; Chemotherapy; Treatment; Surgery; Digestive diseases; Intestinal disease; Clinical trial; Liver metastasis; Cancer
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-010-1297-x

The standard treatment of CRC patients with hepatic metastases is systemic chemotherapy; however, 5-year survival is disappointingly poor despite recent advances. On the other hand, in patients who undergo immediate radical surgical resection of hepatic metastases, 5-year survival reaches 30-40%. Unfortunately, only 15-20% of patients with hepatic metastases are initially eligible for a radical surgical approach. The majority of patients undergoing liver resection relapse after surgery. For this reason, new onco-surgery approaches have been investigated in recent years and the addition of biological agents to chemotherapy, such as bevacizumab and cetuximab, and the improvements of surgical techniques have opened a new scenario in the management of colorectal liver metastases. Recently, the EORTC trial has demonstrated that perioperative chemotherapy (Folfox regimen) is feasible and improves progression-free survival in patients with resectable liver metatsases. Chemotherapy and surgery can finally collaborate. In the unresectable setting, the association of chemotherapy with bevacizumab and cetuximab is particularly promising in improving resectability rate. In particular, K-RAS is a molecular response predictive factor that could be particularly useful in selecting the best treatment option in patients with unresectable liver disease.