Complete Pathologic Response After Preoperative Chemotherapy for Colorectal Liver Metastases: Myth or Reality?

Adam, René; Wicherts, Dennis A.; Haas, Robbert J. de; Aloia, Thomas A.; Lévi, Françis; Paule, Bernard; Guettier, Catherine; Kunstlinger, F; Delvart, V.; Azoulay, Daniel; Castaing, Denis

doi:10.1200/jco.2007.13.7471

Cited by 270 publications

(199 citation statements)

References 28 publications

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“…8,[36][37][38]43,44 It is interesting to note that the downstaging of unresectable liver metastases with modern neoadjuvant chemotherapy regimens has allowed potentially curative resection in up to 30% of patients across published series. 45 Furthermore, a recent analysis revealed that pathologic a complete response to chemotherapy is a major determinant of long-term survival and cure in patients with metastatic CRC.…”

Section: Discussionmentioning

confidence: 99%

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Rescue chemotherapy using multidrug chronomodulated hepatic arterial infusion for patients with heavily pretreated metastatic colorectal cancer

Bouchahda

Adam

Giacchetti

et al. 2009

Cancer

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Original carbohydrate‐based acrylamides bearing one azide group in C‐2 or C‐6 position namely, 2‐[(2‐deoxy‐2‐azido‐α‐D‐mannopyranosyloxy)ethanamido]‐ethyl acrylamide (II) and 2‐[(6‐deoxy‐6‐azido‐α‐D‐glucopyranosyloxy)ethanamido]‐ethyl acrylamide (III), and their azide‐free analogue, 2‐[(α‐D‐glucopyranosyloxy)ethanamido]‐ethyl acrylamide (I), have been designed. Whereas the reversible addition fragmentation chain transfer (RAFT) process ensured the preparation of well‐defined glycopolymers from I, the polymerization of monomers II and III proved to be challenging at temperatures compatible with a thermally initiated radical process, due to the presumed concomitant 1,3‐cycloaddition reactions between the azide and the acrylamide moieties. In contrast to III, for which no polymer could be obtained under any conditions, performing the RAFT polymerization of II at 30 °C clearly favored the radical polymerization and conferred a controlled character to the process, affording well‐defined azide‐functionalized glycopolymers and block copolymers. The presence of numerous azide moieties was finally exploited to introduce carbohydrates onto the glycopolymer backbone through copper catalyzed azide‐alkyne cycloaddition. © 2011 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem, 2011

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Section: Discussionmentioning

confidence: 99%

“…45 Furthermore, a recent analysis revealed that pathologic a complete response to chemotherapy is a major determinant of long-term survival and cure in patients with metastatic CRC. 44 Therefore, a pathologic CR may represent a future surrogate endpoint.…”

Section: Discussionmentioning

confidence: 99%

Rescue chemotherapy using multidrug chronomodulated hepatic arterial infusion for patients with heavily pretreated metastatic colorectal cancer

Bouchahda

Adam

Giacchetti

et al. 2009

Cancer

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“…Pathological response to neoadjuvant chemotherapy has shown prognostic potential in patients with liver metastases from CRC, and consequently it has been integrated as an endpoint in several studies [107][108][109]. The degree of pathological response has been shown to vary depending on the chemotherapy regimen used [107,108].…”

Section: Pathological Responsementioning

confidence: 99%

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

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ABSTRACTpatients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrastenhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes. The group proposed a new system to classify initial unresectability based on technical and oncological contraindications.

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“…In summary, although the current report expands on previous studies indicating an increase in surgical complications with extended preoperative chemotherapy, the jury is still out on whether preoperative bevacizumab should be considered a black sheep in hepatic regeneration in humans. 6,7 …”

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confidence: 99%

In Search of the Black Sheep: Is It Bevacizumab or Extended Chemotherapy?

Vauthey

Zorzi

2009

Ann Surg Oncol

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Complete Pathologic Response After Preoperative Chemotherapy for Colorectal Liver Metastases: Myth or Reality?

Abstract: CPR was observed in 4% of patients with CLM treated with preoperative chemotherapy. However, CPR may occur in almost one-third of objective responders age

Cited by 270 publications

References 28 publications

Rescue chemotherapy using multidrug chronomodulated hepatic arterial infusion for patients with heavily pretreated metastatic colorectal cancer

Rescue chemotherapy using multidrug chronomodulated hepatic arterial infusion for patients with heavily pretreated metastatic colorectal cancer

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

In Search of the Black Sheep: Is It Bevacizumab or Extended Chemotherapy?

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