Neoadjuvant and conversion treatment of patients with colorectal liver metastasis: the potential role of bevacizumab and other antiangiogenic agents.
More than 50 % of patients with colorectal cancer develop liver metastases. Surgical resection is the only available treatment that improves survival in patients with colorectal liver metastases (CRLM). New antiangiogenic targeted therapies, such as bevacizumab, aflibercept, and regorafenib, in combination with neoadjuvant and conversion chemotherapy may lead to improved response rates in this population of patients and increase the proportion of patients eligible for surgical resection. The present review discusses the available data for antiangiogenic targeted agents in this setting. One of these therapies, bevacizumab, which targets the vascular endothelial growth factor (VEGF) has demonstrated good results in this setting. In patients with initially unresectable CRLM, the combination of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) plus bevacizumab has led to high response and resection rates. This combination is also effective for patients with unresectable CRLM. Moreover, the addition of bevacizumab to chemotherapy in the neoadjuvant setting of liver metastasis has a higher impact on pathological response rate. This drug also has a manageable safety profile, and according to recent data, bevacizumab may protect against the sinusoidal dilation provoked in the liver by certain cytotoxic agents. In phase II trials, antiangiogenic therapy has demonstrated benefits in the presurgical treatment of CRLM and may represent a new treatment pathway for these patients.
Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain. pgarcaalfonso@gmail.com.
Pilar
P
García-Alfonso
Medical Oncology Service, Hospital General Universitario de Albacete, Albacete, Spain.
Ana
A
Ferrer
Medical Oncology Service, Hospital Universitario Carlos Haya, Málaga, Spain.
Silvia
S
Gil
Medical Oncology Service, Complejo Hospitalario de Jaén, Jaén, Spain.
Rosario
R
Dueñas
Medical Oncology Service, Hospital de Basurto, Bilbao, Spain.
María Teresa
MT
Pérez
Medical Oncology Service, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
Raquel
R
Molina
Medical Oncology Service, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Jaume
J
Capdevila
Medical Oncology Service, Hospital General Universitario de Valencia, Valencia, Spain.
María José
MJ
Safont
Medical Oncology Service, Complejo Asistencial de León, León, Spain.
Carmen
C
Castañón
Medical Oncology Service, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
Juana María
JM
Cano
Medical Oncology Service, Hospital Obispo Polanco, Teruel, Spain.
Ricardo
R
Lara
D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D020360:Neoadjuvant Therapy
D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab
Antiangiogenic; Bevacizumab; Colorectal liver metastases; Neoadjuvant; Resection; Review