ASCO: Surgery Plus Chemotherapy Improves Recurrence-Free Rate for Liver Metastases

CHICAGO, June 5 -- Recurrence rates for resectable liver metastases from colorectal cancer are lower when neoadjuvant and adjuvant chemotherapy augment surgery, researchers said here. Patients who underwent neoadjuvant and adjuvant chemotherapy achieved a 42.4% rate of recurrence-free survival versus a 33.2% rate for patients treated with surgery alone, said surgeon Bernard Nordlinger, M.D., of Ambroise Pare Hospital of the Assistance Publique-Hospitaux de Paris.
"The 9.2% difference in outcome at 3.9 years was statistically significant (P=0.0025)," Dr. Nordlinger reported at the American Society of Clinical Oncology meeting. "This approach may become the standard of care for patients with liver metastases from colorectal cancer that can be surgically removed."
Dr. Nordlinger and colleagues recruited 364 patients who were evenly randomized to neoadjuvant chemotherapy plus surgery or surgery alone. Three hundred and three patients, 151 in the surgery plus chemotherapy arm and 152 in the surgery arm, completed the study per protocol.
Chemotherapy patients were treated with a FOLFOX4 regimen (oxaliplatin [Eloxatin] at 85mg/m2 plus leucovorin [Welcovorin] and 5-fluorouracil). Patients were given six cycles of FOLFOX4 over a three month period and then were given six more cycles following surgery.
Dr. Nordlinger said that one of the keys of the study was the work performed by the multidisciplinary medical team that worked to determine eligibility for the patients.
"These findings support a multidisciplinary approach to care, with all members of the patient's health care team collaborating to determine the optimal combination of chemotherapy and surgery," he said.
"A lot of people have already begun using chemotherapy both before and after surgery in these patients," commented Stephen Shibata, M.D., of the City of Hope Cancer Center in Duarte, Calif. "This study confirms that the combination is beneficial. We think that the combination is the way to go with these patients who are resected."
The addition of chemotherapy to surgery and the better outcomes percentage was achieved without serious adverse events, Dr. Nordlinger said. He said the toxicity of the neoadjuvant regimen did not prevent patients from undergoing surgery.
"I was most surprised that the toxicity of this regimen was so minimal," commented A. William Blackstock, M.D., of Wake forest University in Winston-Salem, N.C. Dr. Blackstock moderated a press briefing where the study was discussed.