Systemic cytotoxic and biological therapies of colorectal liver metastases

Expert consensus statement

Roderich E. Schwarz, Jordan D. Berlin, Heinz J. Lenz, Bernard Nordlinger, Laura Rubbia-Brandt, Michael A. Choti

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15 years. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liver-only CRLM are at risk of disease recurrence and cancer-related death, combining resection with systemic therapy appears sensible. However, trial-based evidence is sparse to support this concept. Peri-operative FOLFOX has demonstrated a progression-free survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapy-associated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, pre-operative chemotherapy should not extend beyond 3 months. For patients with unresectable liver-only CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatin- or irinotecan-containing combinations represent the standard options, although single-agent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without K-ras mutations, anti-epidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.

Original languageEnglish (US)
Pages (from-to)106-115
Number of pages10
JournalHPB
Volume15
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Biological Therapy
Liver Neoplasms
Neoplasm Metastasis
Liver
Drug Therapy
irinotecan
oxaliplatin
Therapeutics
Hepatic Veno-Occlusive Disease
Survival
Cytotoxins
Wounds and Injuries
Hepatectomy
Fatty Liver
Epidermal Growth Factor Receptor
Disease-Free Survival
Colorectal Neoplasms
Neoplasms
Safety
Recurrence

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Systemic cytotoxic and biological therapies of colorectal liver metastases : Expert consensus statement. / Schwarz, Roderich E.; Berlin, Jordan D.; Lenz, Heinz J.; Nordlinger, Bernard; Rubbia-Brandt, Laura; Choti, Michael A.

In: HPB, Vol. 15, No. 2, 02.2013, p. 106-115.

Research output: Contribution to journalArticle

Schwarz, Roderich E. ; Berlin, Jordan D. ; Lenz, Heinz J. ; Nordlinger, Bernard ; Rubbia-Brandt, Laura ; Choti, Michael A. / Systemic cytotoxic and biological therapies of colorectal liver metastases : Expert consensus statement. In: HPB. 2013 ; Vol. 15, No. 2. pp. 106-115.
@article{015f5b80f78e49188071d4e1fc034eb7,
title = "Systemic cytotoxic and biological therapies of colorectal liver metastases: Expert consensus statement",
abstract = "Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15 years. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liver-only CRLM are at risk of disease recurrence and cancer-related death, combining resection with systemic therapy appears sensible. However, trial-based evidence is sparse to support this concept. Peri-operative FOLFOX has demonstrated a progression-free survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapy-associated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, pre-operative chemotherapy should not extend beyond 3 months. For patients with unresectable liver-only CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatin- or irinotecan-containing combinations represent the standard options, although single-agent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without K-ras mutations, anti-epidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.",
author = "Schwarz, {Roderich E.} and Berlin, {Jordan D.} and Lenz, {Heinz J.} and Bernard Nordlinger and Laura Rubbia-Brandt and Choti, {Michael A.}",
year = "2013",
month = "2",
doi = "10.1111/j.1477-2574.2012.00558.x",
language = "English (US)",
volume = "15",
pages = "106--115",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Systemic cytotoxic and biological therapies of colorectal liver metastases

T2 - Expert consensus statement

AU - Schwarz, Roderich E.

AU - Berlin, Jordan D.

AU - Lenz, Heinz J.

AU - Nordlinger, Bernard

AU - Rubbia-Brandt, Laura

AU - Choti, Michael A.

PY - 2013/2

Y1 - 2013/2

N2 - Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15 years. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liver-only CRLM are at risk of disease recurrence and cancer-related death, combining resection with systemic therapy appears sensible. However, trial-based evidence is sparse to support this concept. Peri-operative FOLFOX has demonstrated a progression-free survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapy-associated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, pre-operative chemotherapy should not extend beyond 3 months. For patients with unresectable liver-only CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatin- or irinotecan-containing combinations represent the standard options, although single-agent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without K-ras mutations, anti-epidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.

AB - Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15 years. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liver-only CRLM are at risk of disease recurrence and cancer-related death, combining resection with systemic therapy appears sensible. However, trial-based evidence is sparse to support this concept. Peri-operative FOLFOX has demonstrated a progression-free survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapy-associated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, pre-operative chemotherapy should not extend beyond 3 months. For patients with unresectable liver-only CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatin- or irinotecan-containing combinations represent the standard options, although single-agent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without K-ras mutations, anti-epidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.

UR - http://www.scopus.com/inward/record.url?scp=84872191543&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872191543&partnerID=8YFLogxK

U2 - 10.1111/j.1477-2574.2012.00558.x

DO - 10.1111/j.1477-2574.2012.00558.x

M3 - Article

VL - 15

SP - 106

EP - 115

JO - HPB

JF - HPB

SN - 1365-182X

IS - 2

ER -