title: The Pharmacological Costs of Complete Liver Resections in Unselected Advanced Colorectal Cancer Patients: Focus on Targeted Agents. A Review of Randomized Clinical Trials.
abstract: BACKGROUND
  The aim of this study was to evaluate the pharmacological costs of conversion chemotherapy with targeted biological agents in an unselected population of advanced colorectal cancer (CRC) patients in order to achieve an R0 liver resection.
  
  
  METHODS
  Full reports and updates of randomized clinical trials (RCTs) that compared at least two front-line therapy regimens with targeted biological agents for advanced CRC patients were selected. The present evaluation was restricted to randomized phase II and III trials. The costs of drugs are at the Pharmacy Hospital and are expressed in euros (€).
  
  
  RESULTS
  Our study began with the evaluation of 683 abstracts. Forty-eight trials were considered appropriate for further analysis. A more in-depth evaluation looking for the trials reporting the liver resection rates following conversion chemotherapy brought to the exclusion of other 37 trials, leaving 11 randomized trials (three phase II trials, including 522 patients and eight phase III trials, including 7191 patients). The pharmacological costs of conversion therapy increased with the substitution of prolonged infusion 5-Fluorouracil by capecitabine and, to a much higher extent, with the introduction of biologicals.
  
  
  CONCLUSIONS
  Two key issues are presented in this review. First, the pharmacological costs of commonly used front line regimens based on the targeted biological agents for the treatment of advanced CRC are highly variable. Second, the performance of the published schemes, in terms of resection rates, depends on patient's selection, tumor characteristics, and on the type of the scheme.
authors.affiliation: Department of Medical Oncology, Mater Salutis Hospital, AULSS 21 della Regione Veneto, Legnago, VR, Italy. giuliani.jacopo@alice.it.|Department of Medical Oncology, ASL 21 della Regione Veneto, Via Gianella 1, 37045, Legnago, VR, Italy. giuliani.jacopo@alice.it.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Giuliani
authors.affiliation: Department of Medical Oncology, Mater Salutis Hospital, AULSS 21 della Regione Veneto, Legnago, VR, Italy.|Department of Medical Oncology, ASL 21 della Regione Veneto, Via Gianella 1, 37045, Legnago, VR, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bonetti
mesh_terms: D015179:Colorectal Neoplasms / Q000150:complications* / Q000473:pathology; D004358:Drug Therapy / Q000191:economics*; D006498:Hepatectomy / Q000191:economics*; D006801:Humans
keywords: Advanced colorectal cancer; Costs of drugs; First-line chemotherapy; Randomized phase II and phase III trials; Targeted biological therapies