Effectiveness of Liver Metastasectomies in Patients With Metastatic Colorectal Cancer Treated With FIr-B/FOx Triplet Chemotherapy Plus Bevacizumab

Effectiveness of intensive medical treatment and secondary liver surgery was evaluated in 50 patients with metastatic colorectal cancer treated with the Fir-B/FOx (triplet chemotherapy plus bevacizumab) regimen. Liver metastasectomies were performed in 26% overall and 54% of patients with liver-only metastases. Integrated treatments significantly improved the clinical outcome of patients with metastatic colorectal cancer with liver-only metastases (progression-free survival, 17 months; overall survival, 44 months) compared with multiple metastatic sites and single compared with multiple liver metastases. Background: Intensive medical treatment increases resection rate of liver metastases in patients with metastatic colorectal cancer (MCRC). The effectiveness of liver metastasectomies was evaluated in patients with MCRC who were treated with previously reported Flr-B/FOx (triplet chemotherapy plus bevacizumab). Patients and Methods: Fifty patients with MCRC enrolled in the reported phase II study were classified according to involved me:astatic sites (liver-only metastatic site, multiple metastatic sites) and the extent of liver metastases (single, multiple). Surgical resectability of liver metastases was evaluated at baseline and every 3 cycles of Flr-B/FOx treatment. The resection rate of liver metastases, activity, and efficacy were evaluated; progression-free survival (PFS) and overall survival (OS) were compared by using the log-rank test. Results: Patients with liver MCRC were 33 of 50 consecutive unselected patients with MCRC: liver limited, 22 patients; multiple metastatic sites, 11 patients. Liver metastasectomies were performed in 13 patients: 26% of 50 patients with MCRC, 39% of 33 patients with liver MCRC. In patients with liver-only MCRC, a secondary liver surgery was performed in 54%: 6 of 9 single and 6 of 13 multiple liver metastases. Also, 1 liver and lung metastasectomy was performed. Pathologic complete responses were achieved in 2 patients (15%). The conversion rate of unresectable liver metastases was 83%. Objective response rate, PFS, OS were, respectively: 84%, 11 and 23 months in 33 liver MCRC; 86%, 17 and 44 months in 22 liver-limited patients. PFS and OS were significantly increased in patients with liver-limited metastases compared with multiple metastatic sites and single compared with multiple liver metastases. Conclusion: The Flr-B/FOx regimen may increase the resection rate of liver metastases and improve clinical outcome of patients with liver-only MCRC