The Landmark Series: Randomized Control Trials Examining Perioperative Chemotherapy and Postoperative Adjuvant Chemother
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REVIEW ARTICLE – COLORECTAL CANCER
The Landmark Series: Randomized Control Trials Examining Perioperative Chemotherapy and Postoperative Adjuvant Chemotherapy for Resectable Colorectal Liver Metastasis Yoshikuni Kawaguchi, MD, PhD1,2, and Jean-Nicolas Vauthey, MD, FACS1 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 1
ABSTRACT Surgical resection remains the only curative treatment option for patients with colorectal liver metastases (CLM). However, the high recurrence rate after resection has led physicians to investigate multidisciplinary treatments combining surgery and medical therapy. Currently, the evidence to support medical therapy in patients with resectable CLM is limited. For patients with resectable CLM, the National Comprehensive Cancer Network Guidelines (version 2.2020) for colon and rectal cancer recommends either upfront surgery and postoperative adjuvant chemotherapy or preoperative chemotherapy followed by surgery and postoperative adjuvant chemotherapy. This article reviews randomized control trials regarding medical therapy before and after curative resection of CLM, and summarizes the updated long-term report of the New EPOC trial which investigated the addition of cetuximab to perioperative chemotherapy for patients with resectable CLM.
The management of colorectal cancer has advanced over the last 20 years. These advancements include improvement of surgical technique, development of irinotecan- and oxaliplatin-containing chemotherapy regimens, and molecular targeted therapy. Surgical resection remains the only curative treatment option for patients with colorectal liver metastases (CLM) and provides 5-year overall
Ó Society of Surgical Oncology 2020 First Received: 30 April 2020 J.-N. Vauthey, MD, FACS e-mail: [email protected]
survival (OS) rates that range from 48 to 58%.1–3 However, the recurrence rate after CLM resection is high, ranging from 48 to 80%.1–3 Because of this, multidisciplinary treatment strategies combining surgery and chemotherapy have been investigated. Currently, for patients with resectable CLM, the National Comprehensive Cancer Network Guidelines (version 2.2020) for colon and rectal cancer recommends either upfront surgery and postoperative adjuvant chemotherapy or preoperative chemotherapy followed by surgery and postoperative adjuvant chemotherapy.4,5 This article reviews the current evidence, based on randomized control trials (RCT), for perioperative treatment strategies for patients with resectable CLM, and summarizes the updated report of the New EPOC trial which investigated the addition of cetuximab to perioperative chemotherapy for patients with resectable CLM. 6 POSTOPERATIVE ADJUVANT CHEMOTHERAPY Postoperative adjuvant chemotherapy after CLM resection is performed in clinical practice because it has proved to be effective for stage III colorectal cancer.7,8 However,
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