Clinical

Perioperative chemotherapy curbs recurrence of colorectal cancer metastatic to liver

Last Updated: 2007-06-04 14:00:36 -0400 (Reuters Health)

By Megan Rauscher

CHICAGO (Reuters Health) - FOLFOX4 chemotherapy given prior to and following surgery for potentially resectable colorectal cancer liver metastases significantly improves progression-free survival over surgery alone and is well tolerated, according results of the first study to date to evaluate the combined approach.

"This treatment should be proposed as the new standard for these patients and, very importantly, should be delivered by a multidisciplinary team," Dr. Bernard Nordlinger from Ambroise Pare Hospital, Paris, France, reported in a plenary session at the 43rd annual meeting of the American Society of Clinical Oncology.

Between 40% and 50% of the one million people diagnosed with colorectal cancer each year develop liver metastases. Until now, the standard of care has been surgery alone to remove the liver tumors when possible but recurrence is common and only 30% to 35% of patients with colorectal cancer liver metastases survive 5 years after surgery.

In the current trial, researchers evaluated the benefit of FOLFOX4 (5-FU, leucovorin and oxaliplatin) given before and after surgery in patients with colorectal cancer liver metastases who were initially candidates for surgery. A total of 182 patients received six cycles of FOLFOX given over 3 months to shrink tumors prior to surgery as well as 6 cycles after surgery; 182 similar patients (controls) were assigned to receive surgery only. A total of 151 patients in the FOLFOX arm and 152 in the control arm underwent surgery.

"The benefit in progression-free survival at 3 years was 9.2%," Dr. Nordlinger reported, "going from 33.2% to 42.4%, with a hazard ratio of 0.73, which means that the risk of relapse was reduced by nearly 30%."

Tolerance to perioperative chemotherapy was "as expected," Dr. Nordlinger noted, and there were no chemotherapy-related deaths. "FOLFOX given perioperatively is safe and does not prevent the patients from undergoing surgery," he concluded.