Secondary hepatic resection as a therapeutic goal in advanced colorectal cancer.
Surgery is the only curative option for patients with liver metastases of colorectal cancer, but few patients present with resectable hepatic lesions. Chemotherapy is increasingly used to downstage initially unresectable disease and allow for potentially curative surgery. Standard chemotherapy regimens convert 10%-20% of cases to resectable disease in unselected populations and 30%-40% of those with disease confined to the liver. One strategy to further increase the number of candidates eligible for surgery is the addition of active targeted agents such as cetuximab and bevacizumab to standard chemotherapy. Data from a phase III trial indicate that cetuximab increases the number of patients eligible for secondary hepatic resection, as well as the rate of complete resection when combined with first-line treatment with the FOLFIRI regimen. The safety profiles of preoperative cetuximab or bevacizumab have not been thoroughly assessed, but preliminary evidence indicates that these agents do not increase surgical mortality or exacerbate chemotherapy-related hepatotoxicity, such as steatosis (5-fluorouracil), steatohepatitis (irinotecan), and sinusoidal obstruction (oxaliplatin). Secondary resection is a valid treatment goal for certain patients with initially unresectable liver metastases and an important end point for future clinical trials.
Saif
Muhammad Wasif
MW
Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06519, United States. wasif.saif@yale.edu
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D000068258:Bevacizumab; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068818:Cetuximab; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005472:Fluorouracil; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D015996:Survival Rate; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D000077146:Irinotecan; D000068818:Cetuximab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
Ann Surg. 2004 Dec;240(6):1052-61; discussion 1061-4
15570210
Ann Surg. 2002 Jun;235(6):759-66
12035031
Ann Surg. 1999 Sep;230(3):309-18; discussion 318-21
10493478
Ann Oncol. 2003;14 Suppl 2:ii13-6
12810452
World J Gastroenterol. 2008 May 28;14(20):3207-11
18506927
J Clin Oncol. 2005 Dec 20;23(36):9063-6
16301589
J Clin Oncol. 2007 May 1;25(13):1670-6
17470860
Ann Surg Oncol. 2009 May;16(5):1208-11
19214636
J Clin Oncol. 2000 Aug;18(16):2938-47
10944126
J Clin Oncol. 2006 Jan 20;24(3):394-400
16421419
J Clin Oncol. 2007 Oct 10;25(29):4593-602
17925554
Ann Surg. 2006 Feb;243(2):236-40
16432357
Ann Oncol. 2005 Mar;16(3):425-9
15677624
J Clin Oncol. 2004 Jan 1;22(1):23-30
14665611
N Engl J Med. 2004 Jun 3;350(23):2335-42
15175435
Lancet. 2008 Mar 22;371(9617):1007-16
18358928
J Clin Oncol. 2004 Apr 1;22(7):1209-14
15051767
J Clin Oncol. 2008 Jul 20;26(21):3523-9
18640933
Ann Oncol. 2004 Mar;15(3):460-6
14998849
Cancer. 2007 Dec 15;110(12):2761-7
17960603
Ann Oncol. 2006 Mar;17(3):450-6
16303861
J Clin Oncol. 2005 Dec 20;23(36):9243-9
16230673
Ann Oncol. 2005 Aug;16(8):1311-9
15870084
J Clin Oncol. 2008 Apr 10;26(11):1830-5
18398148
J Pathol. 1986 Nov;150(3):195-203
3806280
Ann Surg. 2005 May;241(5):715-22, discussion 722-4
15849507
J Clin Oncol. 2004 Jan 15;22(2):229-37
14657227
Ann Oncol. 2007 Feb;18(2):299-304
17060484
J Am Coll Surg. 2001 May;192(5):577-83
11333094
Ann Surg. 2004 Jun;239(6):818-25; discussion 825-7
15166961
Ann Oncol. 1999 Jun;10(6):623-6
10442182
J Clin Oncol. 2008 Nov 20;26(33):5344-51
18936472
J Clin Oncol. 2009 Apr 1;27(10):1572-8
19255321
Q J Nucl Med Mol Imaging. 2009 Apr;53(2):224-44
19293770
J Gastrointest Surg. 2005 Nov;9(8):1148-53; discussion 1153-4
16269386
J Gastrointest Surg. 2009 May;13(5):890-5
19132450
J Gastrointest Surg. 2003 Dec;7(8):1034-44
14675713
J Clin Oncol. 2005 Aug 1;23(22):4866-75
15939922
Ann Oncol. 2003 Oct;14(10):1537-42
14504055
J Surg Oncol. 2004 Nov 1;88(2):78-85
15499601
Ann Surg. 1984 May;199(5):502-8
6721600
Med Oncol. 2005;22(3):303-12
16110141
J Clin Oncol. 1997 Mar;15(3):938-46
9060531
J Clin Oncol. 2005 Jun 1;23(16):3706-12
15867200
Arch Surg. 2002 Jun;137(6):675-80; discussion 680-1
12049538
Br J Surg. 2007 Mar;94(3):274-86
17315288
Br J Cancer. 2006 Mar 27;94(6):798-805
16508637
Abdom Imaging. 2008 Nov-Dec;33(6):676-88
18373114
J Clin Oncol. 2006 May 1;24(13):2065-72
16648507
J Clin Oncol. 2007 Nov 20;25(33):5225-32
18024868
J Clin Oncol. 2009 Feb 10;27(5):663-71
19114683
J Am Coll Surg. 2005 Oct;201(4):517-28
16183489
Ann Surg. 2006 Jan;243(1):1-7
16371728
Gastrointest Cancer Res. 2007 Jan;1(1):20-7
19262699
J Am Coll Surg. 2008 Jan;206(1):96-106
18155574
J Clin Oncol. 2006 Nov 1;24(31):4983-90
17075116
Ann Oncol. 2004 Jun;15(6):933-9
15151951