Patients with stage IV colorectal cancer live longer when tumors in their liver can be removed surgically, but not all patients have cancer that can be operated on.
Separating patients with liver tumors from colorectal cancer into three groups according to possible liver resectability, British doctors found a wide variation in both overall survival and progression-free survival three years later.
A team of surgeons, medical oncologists, and radiologists at the Royal Marsden Hospital in London divided patients in a clinical trial studying CAPOX chemotherapy into three groups:
- A — those whose treatment was considered to be palliative and not treatable with surgery.
- B — those where chemotherapy might convert initially unresectable metastases and make surgery possible.
- C — patients with resectable liver mets receiving neoadjuvant chemotherapy before surgery.
Among 128 patients who were part of the study, 74 were in the palliative group, 22 in the conversion, and 32 in the neoadjuvant groups.
Patients had scans every four chemotherapy cycles, and when it was possible liver surgery was attempted after four or eight cycles.
- Ten patients (45 percent) of the conversion group and 19 (59 percent) of the neoadjuvant group eventually had surgery.
- Three years later, 10 percent of the conversion and 37 percent of the neoadjuvant group were alive and their cancer had not gotten worse (progression-free survival).
Median overall survival for all three groups:
- Palliative treatment — 14.6 months
- Conversion chemotherapy — 24.5 months
- Neoadjuvant chemo — 52.9 months
Patients in the study received CAPOX chemotherapy in three week cycles. The CAPOX regimen was oral Xeloda® (capecitabine) daily for 14 days after an initial infusion of oxaliplatin on day one.
The team concluded,
This prospective study shows the wide variation in outcome according to baseline resectability status and highlights the potential clinical value of a modified staging system to distinguish between these patient subgroups.