Treatment Options for Colorectal Cancer Liver Metastases

Zhiming Zhao,Mengyang Li,Xianglong Tan

doi:10.31487/j.scr.2020.04.04

Abstract

The liver is the most common site of metastasis in colorectal cancer (CRC). Treatment of liver metastases determines the prognosis of patients with CRC. Tremendous progress has been made during the last two decades, which has greatly improved the overall survival of CRC patients. Currently, various treatment options are available, including hepatectomy, liver transplantation, local regional therapy, chemotherapy, targeted therapy, and immune therapy, inevitably leading to some controversies on treatment indications and selection of treatment strategy. Here, we reviewed the existing approaches to treat colorectal cancer liver metastases, with the aim of examining several crucial questions regarding surgical resection, liver transplantation, and medical treatment in clinical practice.

Highlights

For patients with colorectal cancer (CRC), the liver is the most common site of metastasis
Treatment of liver metastasis determines the prognosis of the patients, and improvement in liver metastasis treatment can prolong the overall survival (OS) of CRC patients [1]
A recent randomized controlled trial showed that treatment with hepatic artery infusion (HAI) in combination with cetuximab for wild type KRAS multi-liver metastases showed a high response rate, and 30% of the patients achieved R0/R1 resection, despite some of them being resistant to previous systematic chemotherapy [2]

Summary

Introduction

For patients with CRC, the liver is the most common site of metastasis. Approximately 15 percent of the CRC patients are initially diagnosed with liver metastasis, whereas 50% of the patients experience liver metastasis during the follow-up period. A recent randomized controlled trial showed that treatment with HAI (fluorouracil, irinotecan and oxaliplatin) in combination with cetuximab for wild type KRAS multi-liver metastases (median >10 lesions) showed a high response rate, and 30% of the patients achieved R0/R1 resection, despite some of them being resistant to previous systematic chemotherapy [2]. A recent study showed an impressive 8-year survival rate of 36% in unresectable CRLM patients who received RFA treatment [36]. In wildtype KRAS patients, an anti-EGFR regimen of cetuximab in combination with standard chemotherapy significantly improved the response rate, OS, and progression-free survival [55,56,57]. Cetuximab combined with standard chemotherapy in wild-type KRAS patients improved the conversion resection rate, which was superior to bevacizumab in mutated KRAS patients [52]. PIK3CA alone was not associated with poor outcomes [65]

DC Vaccine

Anti-PD-1 Regimen

Findings

Conclusion