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According to results from a late-breaking session at the 2007 annual meeting of the American Society of Clinical Oncology (ASCO), patients with colorectal cancer whose cancer has spread to the liver (liver metastases) have improved survival without cancer recurrences when they receive chemotherapy prior to and following surgery, compared with those treated with surgery only.

Colorectal cancer remains the second leading cause of cancer-related deaths in the United States. Liver metastases are common among patients with advanced disease, and optimal approaches for patients with liver metastases that are able to be surgically removed (resectable) continue to be evaluated, as it is thought that some of these patients may be cured.

Neoadjuvant chemotherapy refers to a treatment approach in which chemotherapy is used prior to surgery. Neoadjuvant therapy may be utilized to shrink the cancer, allowing for more complete surgical removal. As well, neoadjuvant therapy may also provide the benefit of immediate systemic (full-body) cancer killing effects. However, a concern of neoadjuvant therapy is that it may cause side effects that result in a delay of surgery, during which time the cancer can continue to grow or ultimately prevent the patient from being able to undergo surgery at all.

Adjuvant chemotherapy refers to a treatment approach in which chemotherapy is used following surgery. Adjuvant chemotherapy is used to kill any remaining cancer cells in the body, and is often a standard therapeutic approach in various types of cancer.

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Researchers from France recently conducted a clinical trial to evaluate the use of neoadjuvant and adjuvant chemotherapy in patients with resectable liver metastases from colorectal cancer. This trial included 364 patients who were divided into two treatment groups. One group was treated with neoadjuant chemotherapy consisting of FOLFOX4 (Eloxatin®, leucovorin, 5-fluorouracil) followed by surgery and subsequent adjuvant chemotherapy also consisting of FOLFOX4. The other group of patients was treated with surgery only.

  • At nearly four years follow-up, recurrence-free survival was 42.4% for patients receiving chemotherapy compared with only 33.2% for those treated with surgery only.
  • The addition of chemotherapy did not result in serious side effects. Patients were not prevented from undergoing surgery due to side effects from neoadjuvant chemotherapy.

The researchers concluded that neoadjuvant and adjuvant chemotherapy consisting of FOLFOX4 significantly improves recurrence-free survival compared with surgery alone among patients with resectable liver metastases from colorectal cancer. Furthermore, these improved outcomes may be achieved without significant side effects. Patients with colorectal cancer and liver metastases may wish to speak with their physician about the individual risks and benefits of neoadjuvant and adjuvant chemotherapy.

Reference: Nordlinger B, et al. Final Results of the EORTC Intergroup Randomized Phase III Study 40983 [EPOC] Evaluating the Benefit of Peri-Operative FOLFOX4 Chemotherapy for Patients with Potentially Resectable Colorectal Cancer Liver Metastases. Proceedings from the 2007 annual meeting of the American Society of Clinical Oncology. Late-Breaking Abstract #5.

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