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Journal of Gastrointestinal Cancer

, Volume 47, Issue 4, pp 341–350 | Cite as

The Pharmacological Costs of Complete Liver Resections in Unselected Advanced Colorectal Cancer Patients: Focus on Targeted Agents. A Review of Randomized Clinical Trials

Review Article
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Abstract

Background

The aim of this study was to evaluate the pharmacological costs of conversion chemotherapy with targeted biological agents in an unselected population of advanced colorectal cancer (CRC) patients in order to achieve an R0 liver resection.

Methods

Full reports and updates of randomized clinical trials (RCTs) that compared at least two front-line therapy regimens with targeted biological agents for advanced CRC patients were selected. The present evaluation was restricted to randomized phase II and III trials. The costs of drugs are at the Pharmacy Hospital and are expressed in euros (€).

Results

Our study began with the evaluation of 683 abstracts. Forty-eight trials were considered appropriate for further analysis. A more in-depth evaluation looking for the trials reporting the liver resection rates following conversion chemotherapy brought to the exclusion of other 37 trials, leaving 11 randomized trials (three phase II trials, including 522 patients and eight phase III trials, including 7191 patients). The pharmacological costs of conversion therapy increased with the substitution of prolonged infusion 5-Fluorouracil by capecitabine and, to a much higher extent, with the introduction of biologicals.

Conclusions

Two key issues are presented in this review. First, the pharmacological costs of commonly used front line regimens based on the targeted biological agents for the treatment of advanced CRC are highly variable. Second, the performance of the published schemes, in terms of resection rates, depends on patient’s selection, tumor characteristics, and on the type of the scheme.

Keywords

Advanced colorectal cancer Randomized phase II and phase III trials First-line chemotherapy Targeted biological therapies Costs of drugs 

Notes

Compliance with Ethical Standards

Disclosure of Potential Conflicts of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No funds were received to support this article.

Ethical Approval

This article does not contain any studies with human participants and/or animals performed by any of the authors.

Informed Consent

No human participants were involved in this research.

No writing assistance was utilized in the production of this manuscript.

Authorship

Jacopo Giuliani and Andrea Bonetti contributed equally to (1) conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article and revising it critically for important intellectual content; and (3) final approval of the version to be published.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Medical OncologyMater Salutis HospitalLegnagoItaly
  2. 2.Department of Medical OncologyASL 21 della Regione VenetoLegnagoItaly

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