Patterns of peri-operative systemic therapy in liver-limited metastatic colorectal cancer (mCRC).

Abstract

e14048 Background: Treatment for liver-limited mCRC is increasingly multi-disciplinary, frequently involving systemic therapy and surgery. Our aims were to 1) explore the use and choice of systemic therapy pre- and post-liver resection and 2) examine if specific regimens were associated with improved outcomes. Methods: All patients diagnosed with liver-limited mCRC in British Columbia, Canada from 2006 to 2007 were reviewed. Summary statistics were used to describe surgical and systemic treatment patterns. Kaplan-Meier methodology was used to characterize the relationship between systemic regimen and survival. Results: Among 374 patients, 42% were aged >/=70 years, 60% were men, 24/39/37% were ECOG 0/1/2+, 80% had primary tumor surgery, and 68% received prior adjuvant chemotherapy. For liver metastases, 95 (26%) were offered hepatic resection. Compared to those who did not receive liver surgery, resected patients were younger (median 60 vs 69), had better function (ECOG 0/1 88 vs 55%), largest liver lesion was smaller (median 3 vs 4 cm), and had fewer total lesions (median 1 vs 4) (all p<0.05). Patients who underwent liver surgery also had improved median overall survival (12.0 vs 9.4 months, p<0.05) than those who did not. Among resected patients, 47% received pre-operative chemotherapy: FOLFOX (28%, median 7 cycles), FOLFIRI (18%, median 9 cycles), or capecitabine (1%, median 6 cycles) while 74% received post-operative treatment: FOLFOX (26%, median 3 cycles), FOLFIRI (37%, median 9 cycles), or capecitabine (11%, median 8 cycles). About 15% and 31% of patients also received bevacizumab as part of their pre- and post-operative regimens, respectively. Median overall survival did not differ significantly based on choice of chemotherapy backbone: FOLFOX (13.9 months), FOLFIRI (11.5 months), and capecitabine (10.9 months) (p=0.44) or receipt of bevacizumab: yes (14.5 months) vs no (11.1 months) (p=0.57) Conclusions: In this retrospective cohort of liver-limited mCRC patients, hepatic resection was associated with improved survival. Among those offered peri-operative therapy, FOLFOX, FOLFIRI, and capecitabine, either alone or in combination with bevacizumab, appear to be reasonable options.