Surgery News - September 2007 - (Page 17) SEPTEMBER 2007 • SURGERY NEWS ONCOLOGY 17 Colon Cancer Survival Climbs With Perioperative Chemo B Y P AT R I C E W E N D L I N G Else vier Global Medical Ne ws C H I C A G O — Perioperative chemotherapy with FOLFOX4 can improve progression-free survival in patients with liver metastases from colorectal cancer, according to phase III trial results presented in the plenary session at the annual meeting of the American Society of Clinical Oncology. Progression-free survival at 3 years was 36.2% in all patients assigned to perioperative chemotherapy versus 28.1% in all patients assigned to surgery alone (hazard ratio 0.77, P = .041), Dr. Bernard Nordlinger reported on behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Intergroup study 40983. The benefit was even more pronounced in patients whose metastases were resected, compared with those whose cancer was deemed inoperable despite being seen as resectable when imaging was done, according to Dr. Nordlinger, chair of the department of surgery and oncology at Hôspital Ambroise Paré, Boulogne-Billancourt, France. Progression-free survival at 3 years reached 42.4% for resected patients in the Reversible surgery complications, usually liver insufficiency, were reported in 25.2% of chemotherapy patients and in 15.9% of surgery-only patients. There was one postoperative death in the chemotherapy arm, and two in the surgery-only arm. “Liver metastases are observed in 40%50% of 1 million patients diagnosed with new colorectal cancer worldwide each year. When resected, 5-year survival is close to 35%, but cancer relapse is common,” he said, noting that just 15%-20% of patients are deemed suitable for surgical resection. The phase II EORTC 40051 trial opened in April 2007 and will evaluate modified FOLFOX6 chemotherapy with cetuximab vs. modified FOLFOX6 with cetuximab plus bevacizumab as perioperative treatment in patients with resectable liver metastases from colorectal cancer. In a discussion of EORTC 40983, Dr. Nicholas J. Petrelli said that perioperative chemotherapy with FOLFOX4 is not yet the first choice for resectable colorectal hepatic metastases. He said the results were encouraging, but were weakened by the subgroup analysis. Although chemotherapy offers the potential for control and improved survival, hepatic resection is the only potentially curable treatment for colorectal liver metastases, said Dr. Petrelli, a surgeon and medical director of the Helen F. Graham Cancer Center in Wilmington, Del., and an ACS Fellow. Dr. Petrelli said chemotherapy-induced liver injury is a reality, and stressed the importance of maintaining healthy non–tumor-bearing liver parenchyma prior to surgery. ■ THIS TREATMENT SHOULD BE PROPOSED AS THE NEW STANDARD FOR THESE PATIENTS, AND DELIVERED BY A MULTIDISCIPLINARY TEAM. chemotherapy arm, compared with 33.2% for those in the surgery-only arm (HR 0.73, P = .025). That translates into a nearly 30% reduction in the risk of relapse among chemotherapy patients. “This treatment should be proposed as the new standard for these patients, and very importantly, should be delivered by a multidisciplinary team,” Dr. Nordlinger said. Between September 2000 and July 2004, the EORTC 40983 investigators randomized 364 patients with up to four liver metastases on CT scan to surgery alone or to six cycles before and six cycles after surgery of FOLFOX4 (leucovorin, 5-fluorouracil, oxaliplatin) chemotherapy. Data were reported at a median follow-up of 48 months with a cutoff date of March 2007. The average patient age was 62 years in the chemotherapy arm and 64 years in the surgery arm. Of the 182 patients randomized to chemotherapy, 143 (78.6%) were treated with six cycles of preoperative chemotherapy, 151 (83%) underwent resection, and 80 (43.9%) went on to receive six cycles of postoperative chemotherapy. Of the 182 patients randomized to surgery, 152 (83.5%) were resected. Grade 3 sensory neuropathy was reported in 2.3% of pre- and 9.6% of postoperative chemotherapy patients; grade 3 diarrhea in 8.2% and 5.2%, respectively; and grade 3-4 neutropenia in 18.1% and 34.8%, respectively. There were no chemotherapy-related deaths. http://www.facs.org/clincon2007/index.html
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.