Perioperative systemic treatment can improve disease-free survival (DFS), but not overall survival (OS), in patients with colorectal cancer (CRC) liver metastasis, according to results of a meta-analysis published in The Oncologist.

Based on these findings, the researchers do not recommend uniform use of perioperative systemic therapy in this setting. 

The meta-analysis included 7 phase 2 and 3 randomized clinical trials of 1504 patients with CRC and liver metastasis. Six studies were designed to evaluate postoperative treatment, and 1 was designed to assess pre- and postoperative therapy.  


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Systemic therapies used included fluoropyrimidine monotherapy (4 trials), fluoropyrimidine plus oxaliplatin (FPOX; 3 trials), infusional 5-fluorouracil plus irinotecan (FOLFIRI; 1 trial), and capecitabine plus oxaliplatin (CapeOx) and bevacizumab (1 trial). Surgery alone was the control treatment option in 5 trials.

DFS was the primary endpoint in 6 trials, and OS was the primary endpoint in 1 trial. 

The pooled analysis showed that adding perioperative therapy to surgery significantly improved DFS (hazard ratio [HR], 0.73; 95% CI, 0.63-0.84). However, there was no significant OS benefit with perioperative therapy (HR, 0.88; 95% CI, 0.74-1.05).

Of the systemic treatments examined, fluoropyrimidine monotherapy, FPOX, and FOLFIRI led to a significant DFS benefit, but CapeOx plus bevacizumab did not. None led to an OS benefit. 

“The addition of chemotherapy in the perioperative setting should be individualized with weighing the benefit (only DFS) and risks with the toxicities associated with treatment,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Sonbol MB, Siddiqi R, Uson PLS Jr, et al. The role of systemic therapy in resectable colorectal liver metastases: Systematic review and network meta-analysis. Oncologist. Published online October 14, 2022. doi:10.1093/oncolo/oyac212