Chemotherapy using the FOLFOX 4* regimen both before and after surgery to remove liver tumours secondary to colorectal cancer is more effective than surgery alone in giving patients progression-free survival (PFS). This is the conclusion of authors of an Article in this week's edition of The Lancet.
Liver metastases (secondary cancer) are found in 40-50% of the nearly one million patients worldwide diagnosed with colorectal cancer each year. When surgical resection of these metastases is possible, 5-year survival approaches 35%. However, relapse is common and occurs in 75% of patients. Chemotherapy and surgery can reduce the risk of relapse. Preoperative chemotherapy potentially allows surgery on tumours that have become smaller in response to this chemotherapy, and allows the responsiveness of these tumours to chemotherapy to be assessed to determine whether or not chemotherapy post-operation is also worthwhile.
Professor Bernard Nordlinger, Centre Hospitalier Universitaire Ambroise Paré, Boulogne-Billancourt, Assistance Publique Hopitaux de Paris, France, and colleagues did the EORTC Intergroup trial, which included 364 colorectal cancer patients, each with up to four liver metastases. The patients were randomly assigned to either surgery plus chemotherapy (six cycles before, six cycles after) (182 patients), or surgery alone (182 patients).
In the chemotherapy group, 83% of patients had surgery after a median of six chemotherapy cycles, and 63% also received a median of six cycles post-operation. For randomised patients, there was a trend of increased PFS at three years in the chemotherapy group with 35.4% of patients achieving this, compared with 28.1% in the surgery only group, a relative increase of 26%. When looking specifically at patients eligible for the study, 36.2% achieved PFS in the chemotherapy group compared with 28.1% in the surgery only group, a relative increase of 29%. And when looking specifically at patients who actually had surgery, 42.4% achieved PFS in the chemotherapy group compared with 33.2% in the surgery only group, a relative increase of 28%. Finally, the researchers found that reversible post-operative complications occurred more often after chemotherapy plus surgery (in 25% of patients) than after surgery alone (16%); but less than 1% of patients died after surgery.
The authors conclude: "In all randomised patients the study showed a trend favouring administration of chemotherapy. In all eligible and all resected patients, the benefit of administering chemotherapy was significant."
In an accompanying Comment, Dr Jean-Nicolas Vauthey and Dr Scott Kopetz, University of Texas MD Anderson Cancer Center, Houston, TX, USA, say: "This study confirms the importance of multidisciplinary care and the improved outcomes that are available when we integrate the best of medical and surgical oncology."
Notes to editors: *The FOLFOX 4 chemotherapy regimen is a combination of 5-fluorouracil, folinic acid and oxaliplatin
Professor Bernard Nordlinger, Centre Hospitalier Universitaire Ambroise Paré, Boulogne-Billancourt, Assistance Publique Hopitaux de Paris, France T) +33 1 49095594 / +33 6 08744134 E) bernard.nordlinger@apr.aphp.fr
Dr Jean-Nicolas Vauthey and Dr Scott Kopetz, University of Texas MD Anderson Cancer Center, Houston, TX, USA T) +1 713 792 2022 E) jvauthey@mdanderson.org
PDF OF ARTICLE: http://multimedia.thelancet.com/pdf/press/Colorectalcancer.pdf
Journal
The Lancet