Conversion therapy in patients with colorectal liver metastases

C Villard,M Habib,C Nordenvall,P.J Nilsson,C Jorns,E Sparrelid

doi:10.1016/j.ejso.2021.02.019

Abstract

BackgroundThe occurrence of colorectal liver metastases (CRLM) impairs prognosis, yet long-term survival can be achieved by enabling liver resection. This study aims to describe factors associated with conversion therapy leading to liver surgery and treatment outcome. MethodsA retrospective cohort study was conducted including all patients with CRLM discussed at multidisciplinary team conference at Karolinska University Hospital, Stockholm, Sweden, from 2013 to 2018. Factors associated with conversion therapy and outcome following conversion therapy were analysed with logistic regression and survival analyses. ResultsOut of 1023 patients with CRLM, 100 patients (10%) received conversion chemotherapy, out of whom 31 patients (31%) subsequently underwent liver resection. Patients in whom conversion chemotherapy resulted in liver resection were younger (median age 61 vs. 66 years, p = .024), less likely to have a KRAS/NRAS-mutated primary tumours (25% vs. 53%, p = .039) and more likely to have received anti-EGFR agents (32% vs. 4%, p = .001) than patients progressing during conversion chemotherapy. The median OS for patients treated with conversion chemotherapy leading to liver resection was 24 months, compared to 14 months for patients progressing during conversion chemotherapy, p < .001. The OS for patients progressing during conversion chemotherapy was similar to patients given palliative chemotherapy, approximately 13 months. ConclusionConversion therapy offers a survival benefit in selected patients. Despite treatment advances, the majority of patients undergoing conversion chemotherapy never become eligible for curative treatment.

Highlights

Colorectal cancer primarily metastasizes to the liver and the presence of colorectal liver metastases (CRLM) impairs prognosis [1]
Fluorouracil, Folinic acid and Irinotecan (FOLFIRI) and FOLFIRI þ Bevacizumab were most frequently used in patients receiving conversion therapy, 24 patients (25%) and 13 patients (14%), respectively
Among patients receiving conversion chemotherapy leading to surgery, major liver resection was performed in 23 patients (74%), in addition to liver volume optimization in 15 patients (65%)

Summary

Introduction

Colorectal cancer primarily metastasizes to the liver and the presence of colorectal liver metastases (CRLM) impairs prognosis [1]. An overall survival (OS) of up to approximately 35 months following conversion chemotherapy with subsequent liver resection has been reported, early recurrence occurs in a substantial number of patients [8,9,15,16]. As the median OS following first-line chemotherapy with targeted therapies amounts to 24e30 months in patients with metastatic colorectal cancer, the importance of selecting patients who might benefit from conversion chemotherapy is paramount [17e19]. The occurrence of colorectal liver metastases (CRLM) impairs prognosis, yet long-term survival can be achieved by enabling liver resection. Patients in whom conversion chemotherapy resulted in liver resection were younger (median age 61 vs 66 years, p 1⁄4 .024), less likely to have a KRAS/NRAS-mutated primary tumours (25% vs 53%, p 1⁄4 .039) and more likely to have received anti-EGFR agents (32% vs 4%, p 1⁄4 .001) than patients progressing during conversion chemotherapy. The majority of patients undergoing conversion chemotherapy never become eligible for curative treatment

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