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Conversion Therapy for Initially Borderline/Unresectable Metastases in Colon Cancer: What Is the Best Neoadjuvant Chemotherapy?

  • Systemic Therapies in Colorectal Cancer (RD Kim, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

Resection of metastatic colorectal cancer (mCRC) can dramatically improve overall survival (OS), particularly in patients with isolated colorectal liver metastases (CLMs). In this review, we summarize recent findings and studies addressing chemotherapy ± targeted therapy before and after metastatectomies in patients with CLM.

Recent Findings

For initially unresectable CLM that could become resectable after response to medical therapy, FOLFIRINOX has the highest response and conversion rates and is safely administered with bevacizumab. In RAS wild-type, left-sided tumors, chemotherapy with Epidermal Growth Factor Receptor-targeted therapy should be strongly considered given high (~ 70%) response rates. In patients who present with resectable CLM, there is no clear indication that neoadjuvant chemotherapy improves OS. While the New EPOC trial showed detrimental progression-free survival in the combination arm containing cetuximab in this setting, methodologic issues with that trial have raised questions about the strength of these data.

Summary

Through multidisciplinary management in patients with isolated CLM, the best course of action to effect an R0 resection of all known disease-coupling surgery with medical therapy can significantly improve patient outcomes.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305-6562, USA

    Sigurdis Haraldsdottir

  2. West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, PO Box 9300, 1805 Health Sciences Center South, Morgantown, WV, 26506, USA

    Richard M. Goldberg

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Correspondence to Richard M. Goldberg.

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Sigurdis Haraldsdottir declares that she has no conflict of interest.

Richard M. Goldberg is an advisor to Merck and Merck KGA.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Systemic Therapies in Colorectal Cancer

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Haraldsdottir, S., Goldberg, R.M. Conversion Therapy for Initially Borderline/Unresectable Metastases in Colon Cancer: What Is the Best Neoadjuvant Chemotherapy?. Curr Colorectal Cancer Rep 13, 419–428 (2017). https://doi.org/10.1007/s11888-017-0393-2

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