ASO Author Reflections: The Landmark Series: Randomized Control Trials Examining Perioperative Chemotherapy and Postoper
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: The Landmark Series: Randomized Control Trials Examining Perioperative Chemotherapy and Postoperative Adjuvant Chemotherapy for Resectable Colorectal Liver Metastasis Yoshikuni Kawaguchi, MD1,2, and Jean-Nicolas Vauthey, MD1 1
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; 2Hepato-BiliaryPancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
PAST In the past 20 years, we have seen the following advancements on management of metastatic colorectal cancer. Surgical technique, including staged hepatectomy for bilobar colorectal liver metastases (CLM) was refined, understanding of surgical complexity and genetic heterogeneity of CLM was improved, and effective medical therapies, including oxaliplatin-containing and irinotecancontaining regimens, and molecular-targeted therapies became available.1–4 Resection of CLM remains the only curative treatment for this patient group. However, the recurrence rate is high, approximately 70%, in patients undergoing CLM resection.3 To improve survival after CLM resection, randomized control trials (RCT) to evaluate the effect of perioperative chemotherapy and postoperative adjuvant chemotherapy were reported. PRESENT In this paper,4 we summarize current evidences of perioperative chemotherapy and postoperative adjuvant chemotherapy in patients with resectable CLM. Two RCTs showed that recurrence-free survival (RFS) was significantly better in patients who underwent CLM resection and
Ó Society of Surgical Oncology 2020 First Received: 19 June 2020 Y. Kawaguchi, MD e-mail: [email protected]
received postoperative adjuvant chemotherapy of fluorouracil and folnic acid regimen than in patients undergoing CLM resection alone (Portier et al., 24.4 months vs. 17.6 months, P = 0.028; Hasegawa et al. 17.4 months vs. 8.4 months, P = 0.003). With respect to the strategy of perioperative chemotherapy, RFS was significantly better in patients who received perioperative oxaliplatin-containing regimens and underwent CLM resection than in patients who did not receive chemotherapy although the difference was not statistically significant (18.7 months vs. 11.7 months, P = 0.068). Recently, the New Epoc Trial reported the final analyses.5 This trial compared survival in patients who received perioperative oxaliplatin- or irinotecan-containing regimen alone and underwent CLM resection with or without cetuximab. Contrary to the hypothesis of the study, the OS was significantly worse in patients receiving chemotherapy plus cetuximab than in patients receiving chemotherapy alone (55.4 months vs. 81.0 months, P = 0.036). FUTURE To date, no studies have shown medical therapies associated with improvement in overall survival (OS) in patients undergoing curative resection of CLM. On the basis of the current evidences, for patients with resectable CLM, National Comprehensive Cancer Network Guidelines Version 2.2020 of colon and rectal cancer r
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