title: Liver resection rate following downsizing chemotherapy with cetuximab in metastatic colorectal cancer: UK retrospective observational study.
abstract: OBJECTIVE
  The high objective response rate to cetuximab along with chemotherapy in patients with colorectal liver metastases makes it an effective downsizing protocol to facilitate surgery in those with initially unresectable disease. Adoption of this strategy has been variable in the UK. A retrospective observational study was conducted in 7 UK specialist liver surgical centres to describe the liver resection rate following a downsizing protocol of cetuximab and chemotherapy and to evaluate the quality and efficiency of processes by which the treatment was provided.
  
  
  METHODS
  Data were collected in 2012 by reviewing medical records of patients with colorectal metastases confined to the liver, defined as unresectable without downsizing therapy at first review by a specialist Multi Disciplinary Team (MDT).
  
  
  RESULTS
  Sixty patients were included; 29 (48%) underwent liver resection following cetuximab and chemotherapy. Of the 29, 17 (59% or 28% of all patients) achieved R0 resection and 7 (24% or 12% of all patients) R1 resection. All treated patients were KRAS wild-type.
  
  
  CONCLUSIONS
  In specialist liver surgical centres, where patients are evaluated for liver resection, optimal management by MDT using KRAS testing, cetuximab and chemotherapy results in a 28% R0 resection rate in patients with initially unresectable colorectal cancer liver metastases.
authors.affiliation: University Hospital Aintree, Liverpool, UK.
authors.forename: H
authors.initials: H
authors.lastname: Malik
authors.affiliation: Royal Marsden Hospital, London, UK.
authors.forename: A Z
authors.initials: AZ
authors.lastname: Khan
authors.affiliation: University Hospital of Wales, Cardiff, UK.
authors.forename: D P
authors.initials: DP
authors.lastname: Berry
authors.affiliation: Nottingham University Hospitals, Nottingham, UK.
authors.forename: I C
authors.initials: IC
authors.lastname: Cameron
authors.affiliation: University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: I
authors.initials: I
authors.lastname: Pope
authors.affiliation: Pennine Acute NHS Trust, Manchester, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sherlock
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Helmy
authors.affiliation: Merck Serono Ltd., Feltham, UK.
authors.forename: B
authors.initials: B
authors.lastname: Byrne
authors.affiliation: Formerly of Merck Serono Ltd., Feltham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Thompson
authors.affiliation: pH Associates Ltd., Marlow, Bucks, UK. Electronic address: amandapulfer@phassociates.com.
authors.forename: A
authors.initials: A
authors.lastname: Pulfer
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Davidson
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000068818:Cetuximab; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010043:Outcome and Process Assessment, Health Care; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden; D006113:United Kingdom; D018631:ras Proteins / Q000235:genetics
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C117307:KRAS protein, human; D009944:Organoplatinum Compounds; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins; D000068818:Cetuximab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Cetuximab; Colorectal cancer; Downsizing chemotherapy; Liver resection