According to results from a late-breaking session at the 2007 annual meeting of the American Society of Clinical Oncology (ASCO), patients with resectable liver metastases from colorectal cancer have significantly improved rates of recurrence-free survival when surgery is coupled with neoadjuvant and adjuvant chemotherapy.  

Colorectal cancer remains the second leading cause of cancer-related deaths in the United States. Liver metastases are common among patients with advanced disease, and optimal approaches for patients with liver metastases that are resectable continue to be evaluated, as it is thought that some of these patients may be cured. 

Researchers from France recently conducted a clinical trial to evaluate the use of neoadjuvant and adjuvant chemotherapy in patients with resectable liver metastases from colorectal cancer. This trial included 364 patients who were randomized to two groups (303 patients finished treatment per protocol): one group was treated with neoadjuvant chemotherapy consisting of the FOLFOX4 regimen (Eloxatin® 85 mg/m2 plus leucovorin and 5-fluorouracil) for six cycles over a three month period followed by surgery and an additional six cycles of FOLFOX4 while the other group was treated with surgery alone.  

• At nearly 4 years follow-up, recurrence-free survival was 42.4% for patients receiving chemotherapy compared with only 33.2% for those treated with surgery only (p=0.0025).
• The addition of chemotherapy did not result in serious adverse events. Toxicities associated with neoadjuvant chemotherapy did not prevent patients from undergoing subsequent surgery.

The researchers concluded that neoadjuvant and adjuvant chemotherapy consisting of FOLFOX4 significantly improves recurrence-free survival compared to surgery alone among patients with resectable liver metastases from colorectal cancer. Furthermore, these improved outcomes may be achieved without significant toxicities.  

Reference: Nordlinger B, et al. Final Results of the EORTC Intergroup Randomized Phase III Study 40983 [EPOC] Evaluating the Benefit of Peri-Operative FOLFOX4 Chemotherapy for Patients with Potentially Resectable Colorectal Cancer Liver Metastases. Proceedings from the American Society of Clinical Oncology Conference. Chicago/IL. 2007 Late-Breaking Abstract # 5.