title: Secondary Metastases Resection After Bevacizumab Plus Irinotecan-Based Chemotherapy in First-Line Therapy of Metastatic Colorectal Cancer in a Real-Life Setting: Results of the ETNA Cohort.
abstract: OBJECTIVE
  Resection of metastases after chemotherapy improves survival outcomes of patients with initially inoperable metastatic colorectal cancer (mCRC), yet little data is available for those treated in the first-line setting with bevacizumab plus irinotecan. To provide data on this, the present study described the subgroup of the ETNA cohort who underwent metastases surgery.
  
  
  METHODS
  The population of operated patients was described according to metastatic site (exclusively hepatic, non-exclusively hepatic, and non-hepatic). Factors associated with overall survival (OS) and progression-free survival (PFS) were evaluated using multivariable Cox analysis.
  
  
  RESULTS
  A total of 76 patients (21.1 % of the ETNA cohort) underwent metastases resection: 50 % male, median age 61.9 years, 85.5 % ECOG  ≤ 1, and median duration of bevacizumab use 7.2 months. No surgery-related deaths were observed and 30.6 % of patients had at least one post-operative complication, mainly infections (11.8 % of resections), bleeding complications (3.5 %), or delayed wound healing (2.4 %). Complete remission was higher for those with exclusively hepatic metastases (22/32, 68.8 %) than those with non-exclusively hepatic metastases (12/24, 50.0 %), or non-hepatic metastases (12/20, 60.0 %). Among operated patients, 52.6 % had died after 5 years of follow-up. In multivariable analysis at 2 years of follow-up, death (HR 0.09 [95 % CI 0.02-0.35]) and progression (HR 0.35 [95 % CI 0.23-0.56]) were less likely for patients with complete remission (CR) after surgery R0-R1 or radiofrequency ablation (RFA) [CR RFA] compared with those who were not resected or with R2 resection.
  
  
  CONCLUSIONS
  In real-life practice, bevacizumab with irinotecan in first-line therapy for mCRC allows secondary resection of metastases and survival is more favourable in those with complete remission (R0-R1/CR RFA).
authors: University of Bordeaux, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.
authors: Magali
authors: M
authors: Rouyer
authors: CHU Bordeaux, F-33000, Bordeaux, France. denis.smith@chu-bordeaux.fr.|Service d'Oncologie Médicale, CHU de Bordeaux, F-33075, Bordeaux, France. denis.smith@chu-bordeaux.fr.
authors: Denis
authors: D
authors: Smith
authors: CHU Bordeaux, F-33000, Bordeaux, France.
authors: Christophe
authors: C
authors: Laurent
authors: Institut Bergonié, F-33076, Bordeaux, France.
authors: Yves
authors: Y
authors: Becouarn
authors: CHU Toulouse, F-31059, Toulouse, France.
authors: Rosine
authors: R
authors: Guimbaud
authors: CHU Rouen, F-76031, Rouen, France.
authors: Pierre
authors: P
authors: Michel
authors: CHU Limoges, F-87042, Limoges, France.
authors: Nicole
authors: N
authors: Tubiana-Mathieu
authors: University of Bordeaux, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.
authors: Aurélie
authors: A
authors: Balestra
authors: University of Bordeaux, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.
authors: Jérémy
authors: J
authors: Jové
authors: University of Bordeaux, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.
authors: Philip
authors: P
authors: Robinson
authors: CIC Bordeaux CIC1401, F-33000, Bordeaux, France.|CHU Bordeaux, F-33000, Bordeaux, France.|INSERM, U657, F-33000, Bordeaux, France.
authors: Pernelle
authors: P
authors: Noize
authors: University of Bordeaux, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.|CHU Bordeaux, F-33000, Bordeaux, France.|INSERM, U657, F-33000, Bordeaux, France.
authors: Nicholas
authors: N
authors: Moore
authors: CIC Bordeaux CIC1401, F-33000, Bordeaux, France.|CHU Bordeaux, F-33000, Bordeaux, France.
authors: Alain
authors: A
authors: Ravaud
authors: University of Bordeaux, F-33000, Bordeaux, France.|CIC Bordeaux CIC1401, F-33000, Bordeaux, France.|CHU Bordeaux, F-33000, Bordeaux, France.|INSERM, U657, F-33000, Bordeaux, France.
authors: Annie
authors: A
authors: Fourrier-Réglat
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate
chemical_list: D000068258:Bevacizumab; D000077146:Irinotecan; D002166:Camptothecin