title: A multicentre study of capecitabine, oxaliplatin plus bevacizumab as perioperative treatment of patients with poor-risk colorectal liver-only metastases not selected for upfront resection.
abstract: BACKGROUND
  Perioperative chemotherapy improves outcome in resectable colorectal liver-only metastasis (CLM). This study aimed to evaluate perioperative CAPOX (capecitabine-oxaliplatin) plus bevacizumab in patients with poor-risk CLM not selected for upfront resection.
  
  
  METHODS
  Poor-risk CLM was defined as follows: more than four metastases, diameter >5 cm, R0 resection unlikely, inadequate viable liver function if undergoing upfront resection, inability to retain liver vascular supply, or synchronous colorectal primary presentation. Patients underwent baseline computed tomography, magnetic resonance imaging, and/or positron emission tomography (PET) for staging and received neoadjuvant CAPOX plus bevacizumab, with resectability assessed every four cycles. Primary end point was radiological objective response rate (ORR).
  
  
  RESULTS
  Forty-six patients were recruited, of which 91% underwent PET to ensure metastases confined to liver. Following neoadjuvant CAPOX plus bevacizumab, the ORR was 78% (95% confidence interval 63% to 89%). This allowed 12 of 30 (40%) patients with initial nonsynchronous unresectable CLM to be converted to resectability. In addition, 10 of 15 (67%) patients with synchronous resectable CLM underwent liver resection, with four additional patients being observed alone due to excellent response to neoadjuvant therapy. No grade 3-4 perioperative complications were seen.
  
  
  CONCLUSIONS
  Neoadjuvant CAPOX plus bevacizumab resulted in a high response rate for patients with CLMs with poor-risk features not selected for upfront resection and converted 40% of patients to resectability.
authors.affiliation: Department of Medicine.
authors.forename: R
authors.initials: R
authors.lastname: Wong
authors.affiliation: Department of Medicine. Electronic address: david.cunningham@rmh.nhs.uk.
authors.forename: D
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Department of Clinical Research and Development, Royal Marsden Hospital NHS Foundation Trust, Sutton.
authors.forename: Y
authors.initials: Y
authors.lastname: Barbachano
authors.affiliation: Department of Medicine.
authors.forename: C
authors.initials: C
authors.lastname: Saffery
authors.affiliation: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester.
authors.forename: J
authors.initials: J
authors.lastname: Valle
authors.affiliation: Department of Haematology and Oncology, Royal Bournemouth and Poole Hospital, Dorset.
authors.forename: T
authors.initials: T
authors.lastname: Hickish
authors.affiliation: Department of Academic Surgery.
authors.forename: S
authors.initials: S
authors.lastname: Mudan
authors.affiliation: Department of Diagnostic Imaging.
authors.forename: G
authors.initials: G
authors.lastname: Brown
authors.affiliation: Department of Academic Surgery.
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Histopathology, Royal Marsden Hospital NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wotherspoon
authors.affiliation: Department of Medicine.
authors.forename: A S
authors.initials: AS
authors.lastname: Strimpakos
authors.affiliation: Department of Medicine.
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Medicine.
authors.forename: S
authors.initials: S
authors.lastname: Compton
authors.affiliation: Department of Medicine.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Chua
authors.affiliation: Department of Medicine.
authors.forename: I
authors.initials: I
authors.lastname: Chau
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000068258:Bevacizumab; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D019990:Perioperative Care / Q000379:methods; D012307:Risk Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D005472:Fluorouracil