Comments on: Response to Chemo Before Liver Met Resection Doesn’t Predict Survival

By: Kate Murphy

Kate Murphy — Thu, 10 Sep 2009 18:59:13 +0000

As I understand this study, all the patients included had surgically resectable tumors at the time of diagnosis.

However, some doctors believe in a short (three months or less) course of pre-surgical chemotherapy to test the response to chemo or see if tumors progress.

In my mind, this study casts some doubt on that theory since there was no difference in long-term survival whether or not tumors responded or even got worse.

We do not have very good evidence about whether or not neo-adjuvant chemotherapy makes a difference in survival for patients who initially have resectable tumors.

This is one piece of evidence, but more trials are needed, particularly a trial that randomly assigns patients to chemo or immediate surgery.

By: Susan

Susan — Thu, 10 Sep 2009 17:34:19 +0000

This study puzzles me, and I wish I had more information. If the patients were suitable candidates for surgery with curative intent at time of dx, why give them neo-adjuvant chemo? If they weren’t suitable candidates then, why were the ones who progressed deemed suitable later? I know I was accepted for surgery only because I got great results on neo-ad chemo. If I had progressed, surgery would have been ruled out. It is great that they did so well, but will any tumor board start advocating surgery for people who progress because of this study? As for the 4 indicators of success, do they mean low CEA after chemo and surgery or at time of dx? Ditto size of tumor, before or after? Fascinating Study! Susan

By: j.d.

j.d. — Wed, 17 Jun 2009 03:21:11 +0000

This is a significant study and the result should encourage any patient who is facing the disappointment of not responding to neoadjuvant treatment.

It is worth noting, however, that this study is already somewhat out of date because the chemotherapy being offered to stage 4 patients is now different and almost always includes a biological agent. As the authors conclude: “Because of the small numbers, we were unable to examine the effect of other factors on outcome, such as whether novel agents like bevacizumab and cetuximab improved response and survival.”

It is quite possible that under the current regimens those who respond to neoadjuvant chemo will do better after hepatic resection than those who do not.