Document Detail


Systemic cytotoxic and biological therapies of colorectal liver metastases: expert consensus statement.
MedLine Citation:
PMID:  23297721     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15 years. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liver-only CRLM are at risk of disease recurrence and cancer-related death, combining resection with systemic therapy appears sensible. However, trial-based evidence is sparse to support this concept. Peri-operative FOLFOX has demonstrated a progression-free survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapy-associated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, pre-operative chemotherapy should not extend beyond 3 months. For patients with unresectable liver-only CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatin- or irinotecan-containing combinations represent the standard options, although single-agent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without K-ras mutations, anti-epidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.
Authors:
Roderich E Schwarz; Jordan D Berlin; Heinz J Lenz; Bernard Nordlinger; Laura Rubbia-Brandt; Michael A Choti
Publication Detail:
Type:  Journal Article     Date:  2012-09-24
Journal Detail:
Title:  HPB : the official journal of the International Hepato Pancreato Biliary Association     Volume:  15     ISSN:  1477-2574     ISO Abbreviation:  HPB (Oxford)     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-09     Completed Date:  2013-08-02     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  100900921     Medline TA:  HPB (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  106-15     Citation Subset:  IM    
Copyright Information:
© 2012 International Hepato-Pancreato-Biliary Association.
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MeSH Terms
Descriptor/Qualifier:
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Chemotherapy, Adjuvant
Clinical Trials, Phase III as Topic
Colorectal Neoplasms / diagnosis,  mortality,  pathology,  therapy*
Consensus Development Conferences as Topic
Hepatectomy
Humans
Liver Neoplasms / diagnosis,  mortality,  secondary,  therapy*
Neoplasm Metastasis
Patient Selection
Practice Guidelines as Topic
Radiotherapy, Adjuvant
Survival Analysis
Treatment Outcome
Comments/Corrections
Comment In:
HPB (Oxford). 2013 Feb;15(2):116-8   [PMID:  23297722 ]

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