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What is the standard chemotherapy for colorectal cancer patients with resectable liver metastases?

Nature Clinical Practice Oncology volume 6, pages 14–16 (2009)Cite this article

For many years patients with colorectal cancer and isolated, liver-confined or lung-confined distant metastases have been known to have a substantial chance of long-term survival after surgical metastatectomy. As such, one might want to include this population of patients in adjuvant chemotherapy studies, particularly given their favorable long-term prognosis, which lies somewhere between that observed for patients with stage IIIB–IIIC disease.1 Historically, however, patients with resected metastatic disease have been excluded from adjuvant clinical trials, which has left clinicians to use extrapolation or guesswork for decision-making in regard to adjuvant therapy for this population. A few valiant efforts have been made at studying this patient group.2 In the majority of these studies, however, patients were treated with hepatic arterial infusion.3 None of the trials was powered to demonstrate the small but meaningful differences in overall survival that have interested oncologists in stage III adjuvant studies.

One of the largest studies of postoperative fluorouracil (5-FU)-based therapy was conducted in France and Switzerland by the Fédération Francophone de la Cancérologie Digestive (FFCD) (the ACHBTH AURC 9002 trial); 173 patients were enrolled between the years 1991 and 2001.2 Enrollment was adjusted from a planned 200 patients owing to slow accrual and lack of acceptance by participants of a surgery-only control arm. The primary end point of the study was disease-free survival, and in fact 5-FU given in accordance with the Mayo Clinic schedule resulted in a significant improvement in 5-year disease-free survival (from 26.7% to 33.5%, an absolute difference of 6.8%) compared with untreated patients. Median disease-free survival improved from 17.6 to 24.4 months for patients who received 5-FU postoperatively.2 Multivariate analysis showed chemotherapy to be an independent predictor of improved progression-free survival. Overall survival was not significantly improved—perhaps because of the inadequate sample size—but a similar trend towards improvement was seen with overall survival at 5 years (41.9% versus 51.1% for control and 5-FU arms, respectively). The ACHBTH AURC 9002 study was not published until 2006,2 at which time the EORTC Intergroup phase III study 40983 of perioperative FOLFOX4 versus observation after surgical resection (conducted in a similar population of patients to that of ACHBTH AURC 9002) was well underway.8

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  1. BH O'Neil is Associate Professor and RM Goldberg is Professor and Chief in the Division of Hematology and Oncology at the Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.,

    Bert H O'Neil & Richard M Goldberg

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  1. Bert H O'Neil
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Correspondence to Richard M Goldberg.

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Competing interests

BH O'Neil has received honoraria and research support from Pfizer and Sanofi-Aventis. RM Goldberg declared no competing interests.

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O'Neil, B., Goldberg, R. What is the standard chemotherapy for colorectal cancer patients with resectable liver metastases?. Nat Rev Clin Oncol 6, 14–16 (2009). https://doi.org/10.1038/ncponc1274

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