Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review

Abstract

The liver is the most common site of colorectal cancer metastatic spread. Although metastasectomy is the gold standard for fit patients with resectable colorectal cancer liver metastases (CRLMs), their management after surgical treatment remains controversial. The objective of this systematic review was to collate the currently available data of the agents used in the adjuvant setting in order to define the most optimal therapeutic strategy. A systematic review of the literature was conducted by searching PubMed/Medline and Cochrane library databases. We included studies that evaluated the efficacy, the tolerability and the safety profile of various chemotherapeutic agents that are used as adjuvant treatment after surgical resection of CRLMs. The outcomes of interest were regression-free survival (RFS), disease-free survival (DFS), overall survival (OS) and severe toxicities. From 543 initial articles, 29 publications with 7028 patients were finally included. In general, the results of the eligible studies indicated that adjuvant therapy after resection of CRLMs led to improved RFS/DFS rates, but this benefit did not contribute to a statistically significant prolongation of OS. Moreover, the choice of the therapeutic strategy, namely systematic or regional chemotherapy or the combination of both, did not seem to have a differential impact on patient outcomes. However, these results should be interpreted with caution since the majority of the chosen studies are of low or moderate quality. In this context, further high-quality clinical trials conducted on patient sub-populations with modern therapies are required in order to reduce in-study and between-study heterogeneity and determine which patients are expected to derive the maximum benefit from adjuvant therapy after surgery for CRLMs.

Conversion therapy for advanced hepatocellular carcinoma in the era of precision medicine: Current status, challenges and opportunities

“…Currently, there is no consensus or standard regarding the selection of adjuvant therapy regimens and treatment duration following conversion resection for HCC. However, insights can be drawn from the postoperative adjuvant strategies for liver metastases from colorectal cancer, which typically involve maintaining the pre‐existing chemotherapy regimen for 6 months or adjusting drug dosages and shortening the course of chemotherapy based on patient tolerance 76 . A real‐world study by Pan et al 77 .…”

“…However, insights can be drawn from the postoperative adjuvant strategies for liver metastases from colorectal cancer, which typically involve maintaining the pre‐existing chemotherapy regimen for 6 months or adjusting drug dosages and shortening the course of chemotherapy based on patient tolerance. 76 A real‐world study by Pan et al. 77 found that among advanced HCC patients who underwent FOLFOX‐HAIC‐based conversion therapy, receiving postoperative adjuvant therapy significantly improved long‐term survival outcomes, especially in patients with macrovascular invasion and positive hepatitis B surface antigen.…”

Resection Details, Donor Segment Volume, and Adjuvant Chemotherapy in Patients With Colorectal Cancer and Liver Transplant

“…Liver resection remains the primary treatment for patients with colorectal cancer liver metastases. 1 However, more than 80% of these patients are not eligible for liver resection. 2 For patients with colorectal cancer liver metastases, Dueland et al 3 performed a 2-step liver transplant using the Resection and Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy (RAPID) procedure, which was first described by Line et al 4 in 2015 and demonstrated excellent clinical results.…”

“…Liver resection remains the primary treatment for patients with colorectal cancer liver metastases . However, more than 80% of these patients are not eligible for liver resection .…”