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Intense Combination Chemotherapy Enables Surgery for Initially Unresectable Colorectal Mets

Treated with a combination of three chemotherapy drugs, 1 in 5 patients whose colorectal cancer had spread too far for surgery were able to have operations to remove metastatic tumors.  After five years, a third of them were alive with no sign of cancer.

Doctors in Italy treated 200 stage IV patients with a combination of 5-FU, oxaliplatin, and irinotecan (FOLFOXIRI) during three different clinical trials.  While all three drugs are commonly used to treat colorectal cancer, they are not usually used at the same time.  Initially, all of the patients had cancer that had spread beyond the possibility of having it removed surgically.

After a median time of five and a half months, 20 percent of the patients were able to have surgery to completely remove all visible cancer (R0 resection).   Five years later nearly half (42 percent) were still alive and a third (33 percent) survived eight years.  Almost 1 in 3 (29 percent) had no sign of cancer five years after their surgery.

Although most patients (68 percent) who were able to have surgery had metastatic tumors confined to their livers, some had tumors in other parts of the body that were also removed during surgery.

Gianluca Masi, M.D. and colleagues concluded,

The GONO-FOLFOXIRI regimen allow an R0 surgery in approximately 1 out of 5 unselected patients with initially unresectable metastatic colorectal cancer, and the long-term survival of resected patients is considerable. Neoadjuvant FOLFOXIRI for 3-6 months is safe and not associated with severe liver injury.

SOURCE: Masi et al., Annals of Surgery, Volume 239, Number 3, March 2009.

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