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Conversion surgery after cetuximab or bevacizumab plus FOLFIRI chemotherapy in colorectal cancer patients with liver- and/or lung-limited metastases

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

Some metastatic colorectal cancer (mCRC) patients receive conversion surgery (CS), including metastasectomy after palliative chemotherapy. Although targeted agents significantly improved the outcomes, the clinical outcome of CS in the targeted agent era has not yet been thoroughly investigated.

Methods

We analyzed the clinical data of 96 mCRC patients who initially had unresectable liver- and/or lung-limited metastases and underwent first-line cetuximab or bevacizumab plus FOLFIRI between January 2013 and June 2017.

Results

Liver-limited metastasis was seen in 44 patients (45.8%), lung-limited metastases in 21 patients (21.9%), and both liver and lung metastases in 31 patients (32.3%). Among them, 37 patients (38.5%) received cetuximab, and 59 patients (61.5%) received bevacizumab plus FOLFIRI. Overall response rate was 63.9% and 40.7%, respectively (p = 0.035). After median 8.7 (range 2.5–27.3) months, CS was performed in 11 patients (29.7%) in cetuximab group and 15 patients (25.4%) in bevacizumab group (p = 0.646). Median overall survival has not been reached in R0-resected patients (n = 23), during the median follow-up period of 22.5 (range 9.8–54.5) months. Median disease-free survival was 7.1 (95% CI 2.5–11.7) months: 11.0 (95% CI 3.1–19.0) months in cetuximab group and 3.2 (95% CI 0.0–7.8) months in bevacizumab group (p = 0.422). There was no progression after 18.5 months and disease-free survival reached a plateau at 19.9%.

Conclusions

A substantial proportion of patients could receive CS after cetuximab or bevacizumab plus FOLFIRI chemotherapy. R0-resected patients had excellent overall survival, although 80.1% of them eventually experienced recurrence. Some patients could achieve durable disease-free state.

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Acknowledgements

This research was supported by a Grant of the Seoul National University Bundang Hospital Research Grant (no. 14-2015-024).

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Authors and Affiliations

  1. Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro-173-beon-gil, Seongnam, 13620, Republic of Korea

    Sang-A Kim, Ji-Won Kim, Koung Jin Suh, Jin Won Kim, Jee Hyun Kim & Keun-Wook Lee

  2. Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Won Chang

  3. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Heung-Kwon Oh, Jai Young Cho, Duck-Woo Kim & Sung-Bum Kang

  4. Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Sukki Cho, Kwhanmien Kim & Sanghoon Jheon

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  1. Sang-A Kim
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Correspondence to Ji-Won Kim.

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This study protocol was reviewed and approved by the IRB of the Seoul National University Bundang Hospital (IRB Registration No: B-1805/466-177) and conducted in accordance with the precepts established by the Helsinki Declaration.

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Informed consent for this study was waived due to the retrospective nature of this study.

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Kim, SA., Kim, JW., Suh, K.J. et al. Conversion surgery after cetuximab or bevacizumab plus FOLFIRI chemotherapy in colorectal cancer patients with liver- and/or lung-limited metastases. J Cancer Res Clin Oncol 146, 2399–2410 (2020). https://doi.org/10.1007/s00432-020-03233-7

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