What is the optimal neo-adjuvant treatment for liver metastasis?

Haraldsdóttir, Sigurdís; Wu, Christina; Bloomston, Mark; Goldberg, Richard M.

doi:10.1177/1758834013485111

Cited by 12 publications

(3 citation statements)

References 74 publications

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“…For patients with metastatic colorectal cancer (mCRC), complete surgical resection of the metastatic site is the only possible treatment, allowing the patient to achieve an almost radical effect. However, some patients have tumors that were initially unresectable due to the location, number, size, or other influencing factors of their tumors [ 3 ]. In recent years, the advances in chemotherapy and targeted drugs have opened up the possibility of conversion therapy for mCRC.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of anti-EGFR target agents in patients with potentially resectable metastatic colorectal cancer: a meta-analysis of randomized controlled trials

Wang,

Li,

Huang

et al. 2023

World J Surg Onc

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Background Adding anti-epidermal growth factor receptor (anti-EGFR) target agents to conversion therapy may improve the resection rates and survival of patients with potentially resectable metastatic colorectal cancer (mCRC). This study aims to analyze the efficacy and safety of additional anti-EGFR target agents. Methods A systematic search was conducted on PubMed, Web of Science, Embase, and Cochrane Library. And all relevant studies published in English before January 2023 were collected to explore the impact of additional anti-EGFR targeted agent on the efficacy and safety of patients with potentially resectable mCRC (PROSPERO: CRD42022340523, https://www.crd.york.ac.uk/PROSPERO/). Results This study included a total of 8 articles, including 2618 patients. The overall response rate (ORR) and R0 resection rates of the experimental group were higher than those of the control group, while there was no significant difference in progression-free survival (PFS) and overall survival (OS) between the two groups. In RAS/KRAS wild-type patients, the ORR (RR: 1.20, 95% Cl: 1.02–1.41, p = 0.03), R0 resection rate (RR: 1.60, 95% Cl: 1.17–2.20, p = 0.003), PFS (HR: 0.80, 95% Cl: 0.68–0.93, p = 0.003), and OS (HR: 0.87, 95% Cl: 0.76–0.99, p = 0.031) of the experimental group were higher than those of the control group. While in KRAS mutant patients, there was no statistical difference between the two groups in ORR, R0 resection rate, PFS, and OS. Conclusion The addition of anti-EGFR targeted agents can improve the prognosis of RAS/KRAS wild-type patients with potentially resectable mCRC, while KRAS mutant patients may not benefit. In addition, the overall safety factor was controllable.

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Section: Introductionmentioning

confidence: 99%

The efficacy and safety of anti-EGFR target agents in patients with potentially resectable metastatic colorectal cancer: a meta-analysis of randomized controlled trials

Wang,

Li,

Huang

et al. 2023

World J Surg Onc

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“…Specifically, some patients present with initially unresectable disease due to tumor size, number of lesions, location of lesions, or other poor prognostic factors. However, by administering chemotherapy AE a biologic agent to suitable patients, it is possible to "convert" (via shrinkage and response of tumor lesions to therapy) initially unresectable metastatic lesions for potentially curative resection in a meaningful number of these initially unresectable cases [7].…”

Section: Introductionmentioning

confidence: 99%

The role of cetuximab in converting initially unresectable colorectal cancer liver metastases for resection

Poston

Adam

et al. 2017

European Journal of Surgical Oncology

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In patients with metastatic colorectal cancer (mCRC) predominantly confined to the liver, whether a patient undergoes potentially curative resection of the liver lesions is a well-established principal determinant of long-term survival. There are a number of different agents, both chemotherapeutic and targeted biologic agents, which can aid in shrinking liver tumors, which would have otherwise been unresectable, allowing for potentially curative resection. The aim of this review article is to summarize the available evidence regarding optimal therapeutic strategies for converting initially unresectable metastases for potentially curative resection; we do not discuss patients who present with initially resectable disease. We have taken the approach to review trials that included R0 resection rates as one of the principal study endpoints and specifically enrolled patients with liver-limited disease. Primary tumor location has recently emerged as a putative prognostic and predictive factor in patients with mCRC; however, presently, there is a lack of resectability outcomes differentiating tumor location-defined subgroups, and several ongoing trials and retrospective analyses are anticipated to guide insights in the future. In conclusion, in patients with RAS wild-type mCRC, the data support preferential use of the anti-epidermal growth factor receptor monoclonal antibody cetuximab when combined with standard-of-care infusional doublet chemotherapy regimens (FOLFOX or FOLFIRI) for the conversion of initially unresectable metastases for potentially curative resection. Furthermore, we discuss data involving intensified chemotherapy regimens (i.e., 3-drug backbones such as FOLFOXIRI with or without a targeted biologic agent) to promote the conversion of initially unresectable metastases for potentially curative resection.

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“…Surgical resection is the only chance for cure but only feasible in 15–20% of patients45. Various clinical parameters such as the number and size of lesions, disease free interval, and serum Carcinoembryonic antigen levels, among others have been used to prognosticate these patients.…”

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confidence: 99%

Assessment of pathological response to therapy using lipid mass spectrometry imaging

Patterson

Alabdulkarim

Lazaris

et al. 2016

Sci Rep

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In many cancers, the establishment of a patient’s future treatment regime often relies on histopathological assessment of tumor tissue specimens in order to determine the extent of the ‘pathological response’ to a given therapy. However, histopathological assessment of pathological response remains subjective. Here we use MALDI mass spectrometry imaging to generate lipid signatures from colorectal cancer liver metastasis specimens resected from patients preoperatively treated with chemotherapy. Using these signatures we obtained a unique pathological response score that correlates with prognosis. In addition, we identify single lipid moieties that are overexpressed in different histopathological features of the tumor, which have potential as new biomarkers for assessing response to therapy. These data show that computational methods, focusing on the lipidome, can be used to determine prognostic markers for response to chemotherapy and may potentially improve risk assessment and patient care.

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What is the optimal neo-adjuvant treatment for liver metastasis?

Cited by 12 publications

References 74 publications

The efficacy and safety of anti-EGFR target agents in patients with potentially resectable metastatic colorectal cancer: a meta-analysis of randomized controlled trials

The efficacy and safety of anti-EGFR target agents in patients with potentially resectable metastatic colorectal cancer: a meta-analysis of randomized controlled trials

The role of cetuximab in converting initially unresectable colorectal cancer liver metastases for resection

Assessment of pathological response to therapy using lipid mass spectrometry imaging

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