Treatment of Metastatic Colon Cancer: "The Times They Are A-Changing"

摘要: In the 1950s, colon cancer was poor stepchild for chemotherapists, with a median survival of 12 months patients metastatic disease. Now disease, even hepatic metastases, can survive 5 years when surgical techniques liver resection and new chemotherapy, or without targeted agents, are used. article that accompanies this editorial, Ye et al prospectively randomly assigned unresectable, liver-limited metastases (KRAS wild type) to systemic chemotherapy cetuximab (Cetx). The primary end point number converted resection. receiving plus Cetx had significantly higher rate: 25% versus 7.4%. were well matched individual prognostic factors, but two study groups differed slightly: high clinical risk score 35%; rectal primaries, 38% 48%; lesion larger than cm, 44% 55%; major vessel involvement, 37% 44%, group group, respectively. Overall, 22% fewer indicators. This may explain why who underwent did not receive shorter those received (median survival, 22 v 34.8 months, respectively). 5-year rates obtained resection, 30% 50%, superior alone. Early studies showed one three metastases. More recent have shown is possible in greater volume Currently, main consideration total whether enough viable be preserved provide adequate function. What about initially unresectable disease becomes resectable after chemotherapy— what their survival? French investigators withunresectablediseasewhosediseasebecomesresectableafterchemotherapy similar prognosis as whose resectable, survivals 33% group. To examine long-term outcomes: 184 became followed more, 27% 10-year survival. There chance achieving Others reported 23% actual downstaged patients. trials should address neoadjuvant therapy useful and, if so, type A European Organisation Research Treatment Cancer (EORTC) used both preoperative postoperative stated beneficial, given there an increase 3-year disease-free (DFS) treated surgery alone (36.2% 27.8%, respectively, eligible patients). no difference (51.2% 47.8%). benefit clear because preand therapy. Ninety-four percent these other favorable characteristics. Do good characteristics need chemotherapy? Are poor-risk would helped by best regimen? attempts answer conversion question. For trial, definition resectability? multidisciplinary hepatobiliary team needed certain types less likely made such involvement veins inferior vena cava involvement? Memorial SloanKettering Center trial outlined reasons unresectability each patient then which thus providing framework compare studies. do from resection? some recurrence rate? enable more undergo portal vein embolization, two-stage radiofrequency ablation, produce rate recurrence? These questions addressed future trials. Is adjuvant useful? initial randomized fluorouracil/leucovorin treatment show progression-free multivariable pooled analysis significant benefit. Adding irinotecan overall DFS. Infusional fluorouracil, leucovorin, oxaliplatin has been tested study. JOURNAL OF CLINICAL ONCOLOGY E D I T O R L VOLUME 31 NUMBER 16 JUNE 1 2013