Current Status of Biologics in Perioperative Treatment for Resectable or Borderline Resectable Liver Metastases

Abstract

This review provides an overview of the current role of biologics, anti-vascular endothelial growth factor (VEGF) inhibitors and anti-epidermal growth factor receptor (EGFR) inhibitors, in the perioperative treatment of colorectal liver metastases as well as a discussion of their future trends. Over the past decade, a number of clinical trials have suggested that the use of biologics with cytotoxic agents may increase median overall survival in certain subsets of patients with colorectal liver metastases. The benefit of these agents is limited to borderline resectable and unresectable hepatic metastases and is not seen in upfront resectable disease. In the RAS wild-type population, the difference in efficacy of VEGF and EGFR inhibitors in combination with chemotherapy is minimal. These agents perform differently depending on primary tumor location; bevacizumab has greater efficacy in right-sided tumors, whereas cetuximab has greater efficacy in left-sided tumors. While biologics benefit patients in the neoadjuvant setting, studies have not shown similar results in the adjuvant setting. Given the variability of patient presentations as well as the risk of treatment-related toxicity, the addition of biologics requires careful consideration of patient’s medical fitness, surgical risk, and tumor profile.