Resection of colorectal liver metastases with second-line aflibercept plus FOLFIRI: Results from the RESECTION prospective French cohort

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AimTo evaluate R0/R1 resection rate in patients with colorectal liver metastases (CLM) treated with aflibercept plus FOLFIRI after failure of a prior oxaliplatin-based regimen in daily clinical practice. MethodsThis French, multicentre, prospective, observational cohort (NCT05178745) included patients with CLM (alone or predominant; up to 5 lung nodules <2 cm allowed) initiating aflibercept/FOLFIRI every 2 weeks per physician choice. Primary endpoint was R0/R1 resection rate. Secondary endpoints included overall survival (OS), progression-free survival (PFS), radiological and pathological responses, and safety. ResultsA total of 137 patients (median age 65 years, RAS/BRAF mutant 57%/9%) were enrolled at 22 French sites. CLM (median 4) were synchronous in 82%, bilobar in 71% and located in liver only in 54%. Overall, 17% of patients had R0/R1 resection (21% for patients with liver-only disease). A major pathological response per Blazer score was observed in 55% of resected patients, along with significantly longer OS (median 34.8 vs 9.1 months, p<0.0001) and PFS (median 11.4 vs 4.9 months, p<0.0001) compared to non-resected patients. Post-operative complications occurred in 17% of patients (all Dindo-Clavien grade I-II) with no post-operative deaths. Overall, 34% had grade ≥3 adverse events, mainly general health deterioration and diarrhea. ConclusionsResults suggest that aflibercept plus FOLFIRI, after failure of a prior oxaliplatin-based regimen, allows R0/R1 resection of CLM in almost 20% of patients with a major pathological response in most cases and a median OS prolonged by more than 3-fold versus non-resected patients.