Researchers involved in an international multicenter randomized trial have reported that perioperative chemotherapy improves outcomes of patients with colorectal cancer metastases to the liver. The details of this study appeared in the March 22, 2008 issue of The Lancet.¹

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. 

The current trial evaluated 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: 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.  Three-hundred-forty-two patients were included in the final-intent-to-treat analysis (171 in each group). One-hundred-fifty-one patients in the chemotherapy group and 152 in the surgery-alone group actually underwent surgical resection. 

At three years of observation, the group who received chemotherapy had a 7.3% improvement in progression-free survival. The improvement was 9.2% in patients undergoing surgical resection. There were 64 deaths in the chemotherapy group and 75 in the surgery-alone group. There was one post-operative death in the chemotherapy group and two in the control group. There were more side effects in the chemotherapy group, but all were described as reversible.

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

Comments: This study suggests that perioperative chemotherapy is of benefit with modest toxicity in patients with hepatic metastases from colorectal cancer. 

Related News:

Recurrence Rates for Liver Metastases Reduced When Neoadjuvant and Adjuvant Chemotherapy are Used With Surgery (6/6/2007)

Surgery Is Optimal Treatment for Solitary Liver Metastases from Colorectal Cancer (8/29/2006)

Laparoscopy with Intraoperative Ultrasound Sonography Helpful in Evaluating and Treating Colorectal Hepatic Metastasis (08/22/2005)

Reference:

¹ Nordinger B, Sorbye H, Glimellius B, et al. Perioperative chemotherapy with FOLFOXX4 and surgery versus surgery alone for respectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomized controlled trial. The Lancet. 2008;371:1007-10016.