Comparison of two treatment combinations for colorectal cancer patients not eligible for liver surgery

The authors assessed the safety and efficacy of two treatment combinations for colorectal cancer patients who have liver invasion but who are not eligible for surgery.

For patients with colorectal cancer the cancer is most likely to invade the liver if it spreads. Surgery is the best treatment option if the cancer has spread to the liver. However, in some cases patients are not eligible for surgery. A number of conditions can make patients ineligible, including the amount of the liver affected or if the cancer is touching major blood vessels.

For patients who are not initially eligible for surgery, anti-cancer drug combinations can improve their chance of becoming eligible. It is not clear which anti-cancer drug combinations offer patients the best chance of becoming eligible for surgery.

This study included 80 patients with colorectal liver metastases who were not eligible for liver surgery. The patients were randomly divided into two groups. Group 1 included 41 patients were treated with bevacizumab (Avastin) plus the chemotherapy FOLFOXIRI (5-fluorouracil [Efudex], leucovorin, oxaliplatin [Eloxatin], irinotecan [Camptosar]). Group 2 included 39 patients who were treated with bevacizumab plus the chemotherapy FOLFOX-6 (5-fluorouracil, leucovorin, oxaliplatin).  The number of patients eligible for surgery following treatment was assessed, as was the time it took for the cancer to progress. The rate of adverse events was also recorded.

61% of patients in group 1 were eligible for liver surgery after treatment compared to 49% of patients in group 2. The liver surgery completely removed the cancer in 49% of patients in Group 1, compared to 23% of patients in Group 2. It took longer for the cancer to progress for patients in group 1 than patients in Group 2 (18.6 months compared to 11.5 months).

Severe adverse events included neutropenia (low levels of white blood cells, cells needed to fight infections) and diarrhea. 50% of patients from Group 1 had severe neutropenia compared to 35% of patients from Group 2. 30% of patients from Group 1 had severe diarrhea compared to 14% of patients from Group 2. 

The authors concluded that bevacizumab plus FOLFOXIRI treatment was more effective than bevacizumab plus mFOLFOX-6 at improving patients’ eligibility for surgery. However, the rate of severe adverse events was higher in the bevacizumab plus FOLFOXIRI group.

This work was supported by F. Hoffmann-La Roche Ltd., the manufacturers of bevacizumab.