Initially unresectable colorectal liver metastases: the best therapeutic regimens

Abstract

Despite the advances in systemic chemotherapy and molecular targeted therapy, local treatment, including resection and local ablative treatment, is the only treatment of choice that can provide prolonged survival in patients with colorectal liver metastases. Therefore, for initially unresectable colorectal liver metastases, a sufficient response to optimal systemic chemotherapy with biological targeted drugs to allow subsequent surgical treatment would be an important development and could lead to improvemnts in long-term survival. However, the diversity of this complex disease, including molecular and genetic alterations and embryologic origin of the primary tumour, the small number of trials, and the absence of a universal definition for surgical resectability or unresectability complicates the development of a consensus on optimal therapeutic approaches. First-line systemic treatment strategies in patients with initially unresectable colorectal cancer liver metastases (CAIRO5): an open-label, multicentre, randomised, controlled, phase 3 study from the Dutch Colorectal Cancer GroupIn patients with initially unresectable colorectal cancer liver metastases, FOLFOXIRI-bevacizumab was the preferred treatment in patients with a right-sided or RAS or BRAFV600E mutated primary tumour. In patients with a left-sided and RAS and BRAFV600E wild-type tumour, the addition of panitumumab to FOLFOX or FOLFIRI showed no clinical benefit over bevacizumab, but was associated with more toxicity. Full-Text PDF