title: A single-institution experience with bevacizumab in the treatment of metastatic colorectal cancer and in conjunction with liver resection.
abstract: BACKGROUND
  Bevacizumab is active in the treatment of metastatic colorectal cancer (mCRC). However, efficacy of bevacizumab has predominantly been evaluated on selected patients with relatively good performance status and minor comorbidities. We evaluated the efficacy and safety of bevacizumab in unselected patients with mCRC, some of whom underwent liver resection.
  
  
  METHODS
  All patients with inoperable mCRC, fit for combination chemotherapy (n=180), who were initially not resectable, not included into studies and without contraindications to bevacizumab, and initiated on bevacizumab at the Helsinki University Central Hospital between April 2004 and December 2005 were included (n=114). Most (n=70) received 5-fluorouracil/leucovorin/irinotecan plus bevacizumab as first-line therapy. The remainder (n=44) of the patients received bevacizumab in combination with oxaliplatin or irinotecan with or without 5-fluorouracil or capecitabine. Minimum follow-up was 7 years. Treatment response was evaluated every 8-10 weeks according to RECIST criteria.
  
  
  RESULTS
  Median age was 59.6 years (range 35-79); male/female ratio was 54%/46%; World Health Organization performance status 0/1/2-3 was 33%/55%/11%, respectively; and the number of metastatic sites, one/two/three or more, was 31%/21%/48%, respectively. Median duration of bevacizumab therapy was 7.8 months (range 0.5-70.5 with pauses). In first-line (n=40), response rate (RR) was 62%, progression-free survival (PFS) 11.7 months, and overall survival (OS) 22.1 months. In second-line (n=43), RR was 44%, PFS 8.7 months, and OS 18.7 months. In later lines (n=31), RR was 14%, PFS 6.7 months, and OS 14.2 months. Ten patients with initially unresectable liver metastases became operable and R0 resection was achieved in 90% (9/10 resections). In 23% (7/31) of operated metastases, no vital tumor cells were found in histologic examination. Operative morbidity was low: two mild infections, no increased bleeding tendency was noticed, and no impaired wound healing occurred.
  
  
  CONCLUSIONS
  Bevacizumab-containing combination therapy was effective with acceptable tolerability in an unselected mCRC patient population in which liver resections could be safely performed.
authors: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland ; Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.
authors: Pia
authors: P
authors: Osterlund
authors: Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland ; Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors: Reetta
authors: R
authors: Peltonen
authors: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
authors: Tuomo
authors: T
authors: Alanko
authors: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland ; Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.
authors: Petri
authors: P
authors: Bono
authors: Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland ; Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors: Helena
authors: H
authors: Isoniemi
keywords: colorectal cancer; everyday clinical practice; liver resection; metastatic