Possible new treatment plan for colorectal cancer patients with liver metastases

This study investigated the benefits of combination drug therapy (mFOLFOX6 and bevacizumab) for patients with colorectal cancer that has spread to the liver (liver metastases). 

The 5-year survival rate is lower for colorectal cancer patients if the cancer has spread (metastasized) to other organs (stage IV). In 60% of patients with stage IV colorectal cancer it has spread to the liver. For patients with liver metastases the best treatment option is surgical removal of the tumor (resectable hepatectomy). However in some cases it is not possible to surgically remove the tumor (unresectable), due to the size of the tumor or the number of tumors.

To improve the curative surgery rates for patients with liver metastases new treatments are needed. Chemotherapy treatment with mFOLFOX6 (leucovorin calcium, 5-fluorouracil and oxaliplatin) may improve patient outcome. The addition of biologics (a medicine extracted from biological sources e.g. produced by cell lines) such as bevacizumab (Avastin, blocks the creation of blood vessels the tumor needs for growth) may further improve patient outcomes.

This study examined whether a combination of mFOLFOX6 and bevacizumab could increase the rates of curative surgery in 45 patients with colorectal cancer that had spread to the liver. After initial examination 18 of the patients were eligible for liver surgery. All 45 patients received a 6-cycle treatment plan including mFOLFOX6 and bevacizumab therapy. Hepatectomy was reconsidered after the sixth cycle and was performed if possible.

Of the 18 patients rated as resectable before drug treatment, 18 completed 6 cycles of treatment and then underwent liver surgery. For 16 of those patients, the surgery was curative.

Of the 26 initially unresectable patients, 6 underwent liver surgery after the 6 cycle treatment. For 4 of the patients the surgery was curative. Overall curative liver surgery was achieved in 44.4% of patients.

The chemotherapy associated adverse events (negative side effects) and liver surgery complications were both within acceptable ranges. The most common moderate to severe adverse events included decreases in immune cells, fatigue and high blood pressure. 4 patients who had liver surgery had severe complications after the surgery. Complications included infections and delayed wound healing.

The authors concluded that a combination of mFOLFOX6 and bevacizumab yielded a high hepatectomy rate.  They also reported that a high percentage of initially unresectable patients became suitable candidates for surgery following treatment.