Review
Copyright ©The Author(s) 2017.
World J Clin Oncol. Jun 10, 2017; 8(3): 190-202
Published online Jun 10, 2017. doi: 10.5306/wjco.v8.i3.190
Table 1 Recommendations for perioperative and conversion therapy (adapted from ESMO 2016[110])
Perioperative treatment
It is defined by technical criteria for resection and prognostic considerations
It may not be necessary in patients with clearly resectable disease and favourable prognosis, in this case upfront resection is justified
It should administer FOLFOX or CAPOX to patients with resectable disease and unclear (probably unfavourable)
Targeted agents should not be used in resectable patients with prognostic indication for perioperative treatment
It should be considered when prognostic and resectability criteria are unclearly defined, and in patients with synchronous onset of metastases
Adjuvant chemotherapy is not strongly indicated for patients with favourable oncological and surgical criteria, who did not receive any neoadjuvant chemotherapy
Adjuvant chemotherapy is indicated for patients with unfavourable criteria
Adjuvant treatment with FOLFOX or CAPOX is recommended for patients who have not received any previous chemotherapy, unless patients already received oxaliplatin-based adjuvant chemotherapy
The choice of chemotherapy type should consider patients’ clinical conditions and therapy preferences
Conversion therapy
A chemotherapy regimen leading to high response rates and/or a large tumour shrinkage is recommended for potentially resectable patients
The best drug combination to use is still not clear because only few trials have addressed this issue:
RAS wild-type patients may benefit from a cytotoxic doublet plus an epidermal growth factor receptors agents antibody (best benefit/risk), and from the combination of FOLFOXIRI plus bevacizumab and, to a lesser extent, from a cytotoxic doublet plus bevacizumab
RAS mutant patients may benefit from a cytotoxic doublet plus bevacizumab or FOLFOXIRI plus bevacizumab
Patients must be re-evaluated regularly (every 2-3 mo) to prevent the overtreatment of resectable patients
Table 2 Conversion rates in colorectal cancer liver metastases after perioperative chemotherapy
Trial nameChemotherapy typeControlnKRAS statusOverall responseConversion to resectionR0 resection
BEAT[61]FOLFOX/XELOX/FOLFIRI or fluoropyrimidines + bevacizumabNo1914Not selectedNA11.80%NA
First BEAT[62]FOLFOX/XELOX + bevacizumabPlacebo1914Not selected38%11.80%6.3% vs 4.9%
OPUS[70]FOLFOX + cetuximabFOLFOX233Wilde type61% vs 37%9%4.7% vs 2.4%
POCHER[72]Chr IFLO + cetuximabNo43Wild type79%60%25.70%
PRIME[77]FOLFOX + panitumumabFOLFOX591Wild type57% vs 48%31% vs 22%29% vs 17%
CELIM[11]FOLFOX6 + cetuximabFOLFIRI + cetuximab106Wild type68% vs 57%43%38% vs 30%
BOXER[63]CAPOX + bevacizumabNo47Not selected78%40%NA
Loupakis et al[55]FOLFOXIRI + bevacizumabFOLFIRI + bevacizumab508Not selected65% vs 53%15% vs 12%NA
Ye et al[73]FOLFIRI + cetuximabFOLFOX + cetuximab177Wild type57% vs 29%26% vs 7%NA
CRYSTAL[71]FOLFIRI + cetuximabFOLFIRI599Wilde type47% vs 39%16%4.8% vs 1.7%
OLIVIA[79]FOLFOXIRI + bevacizumabFOLFOX + bevacizumab80Not selected81% vs 62%61% vs 49%49% vs 23%