Predictive Factors for the Benefit of Perioperative FOLFOX for Resectable Liver Metastasis in Colorectal Cancer Patients (EORTC Intergroup Trial 40983)
ABSTRACT In EORTC study 40983, perioperative FOLFOX increased progression-free survival (PFS) compared with surgery alone for patients with initially 1 to 4 resectable liver metastases from colorectal cancer (CRC). We conducted an exploratory retrospective analysis to identify baseline factors possibly predictive for a benefit of perioperative FOLFOX on PFS.
The analysis was based on 237 events from 342 eligible patients. Cox proportional hazards regression models with a significance level of 0.1 were used to build up univariate and multivariate models.
After adjustment for identified prognostic factors, moderately (5.1-30 ng/mL) and highly (>30 ng/mL) elevated carcinoembryonic antigen (CEA) serum levels were both predictive for the benefit of perioperative chemotherapy (interaction P = 0.07; hazard ratio [HR] = 0.58 and HR = 0.52 for treatment benefit). For patients with moderately or highly elevated CEA (>5 ng/mL), the 3-year PFS was 35% with perioperative chemotherapy compared to 20% with surgery alone. Performance status (PS) 0 and BMI lower than 30 were also predictive for the benefit of perioperative chemotherapy (interaction P = 0.04 and P = 0.02). However, the number of patients with PS 1 and BMI 30 or higher were limited. The benefit of perioperative therapy was not influenced by the number of metastatic lesions (1 vs 2-4, interaction HR = 0.98).
Perioperative FOLFOX seems to benefit in particular patients with resectable liver metastases from CRC when CEA is elevated and when PS is unaffected, regardless of the number of metastatic lesions.ClinicalTrials.gov number NCT00006479.
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ABSTRACT: Metastatic colorectal cancer is the third most common cancer in the United States with 20 % of the patients presenting with metastatic disease on initial presentation. Sites of metastases are usually to the liver and lung, and less commonly to the peritoneum. Oligometastatic disease may be treated with the combination of systemic chemotherapy, locoregional chemotherapy and surgery to improve survival rates. Thus, the unique setting of adjuvant chemotherapy in metastatic colorectal cancer will be reviewed in this paper.Current Colorectal Cancer Reports 09/2012; 8(3). DOI:10.1007/s11888-012-0130-9
- European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 07/2012; 38(10):1011. DOI:10.1016/j.ejso.2012.07.005 · 2.89 Impact Factor
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ABSTRACT: Surgery is the reference treatment of resectable colorectal liver metastases (CLM) as it is associated with 5-year survival rate as high as 50 % in selected patients. Unfortunately, most patients have too advanced metastatic disease to undergo liver resection with curative intent and are therefore treated by systemic chemotherapy. In patients undergoing resection of CLM, disease recurrence can occur in up to 70 % and consequently, adjuvant treatment to surgery have been tested to improve oncologic outcome. In patients with unresectable CLM, chemotherapy is initially the sole treatment option. The considerable improvement of the efficacy of anticancer agents has contributed to increase the response rate in patients with advanced colorectal cancer. In case of major response to chemotherapy, surgery with curative intent can be offered to patients with initially unresectable liver metastases.Current Colorectal Cancer Reports 09/2012; 8(3). DOI:10.1007/s11888-012-0135-4