Journal ArticleDOI
Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial.
Gunnar Folprecht,Thomas Gruenberger,Wolf O. Bechstein,Hans-Rudolf Raab,Florian Lordick,Jörg T. Hartmann,Hauke Lang,Andrea Frilling,Jan Stoehlmacher,Jürgen Weitz,Ralf Konopke,Christian Stroszczynski,Torsten Liersch,Detlev Ockert,Thomas Herrmann,Eray Goekkurt,Fabio Parisi,Claus-Henning Köhne +17 more
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In this paper, the effectiveness of cetuximab combined with chemotherapy in this setting was assessed, and the primary endpoint was tumour response assessed by Response Evaluation Criteria In Solid Tumours (RECIST), analysed by modified intention to treat.Abstract:
Summary Background Neoadjuvant chemotherapy for unresectable colorectal liver metastases can downsize tumours for curative resection. We assessed the effectiveness of cetuximab combined with chemotherapy in this setting. Methods Between Dec 2, 2004, and March 27, 2008, 114 patients were enrolled from 17 centres in Germany and Austria; three patients receiving FOLFOX6 alone were excluded from the analysis. Patients with non-resectable liver metastases (technically non-resectable or ≥5 metastases) were randomly assigned to receive cetuximab with either FOLFOX6 (oxaliplatin, fluorouracil, and folinic acid; group A) or FOLFIRI (irinotecan, fluorouracil, and folinic acid; group B). Randomisation was not blinded, and was stratified by technical resectability and number of metastases, use of PET staging, and EGFR expression status. They were assessed for response every 8 weeks by CT or MRI. A local multidisciplinary team reassessed resectability after 16 weeks, and then every 2 months up to 2 years. Patients with resectable disease were offered liver surgery within 4–6 weeks of the last treatment cycle. The primary endpoint was tumour response assessed by Response Evaluation Criteria In Solid Tumours (RECIST), analysed by modified intention to treat. A retrospective, blinded surgical review of patients with radiological images at both baseline and during treatment was done to assess objectively any changes in resectability. The study is registered with ClinicalTrials.gov, number NCT00153998. Findings 56 patients were randomly assigned to group A and 55 to group B. One patient in each group were excluded from the analysis of the primary endpoint because they discontinued treatment before first full dose, one patient in group B was excluded because of early pulmonary embolism. A confirmed partial or complete response was noted in 36 (68%) of 53 patients in group A, and 30 (57%) of 53 patients in group B (difference 11%, 95% CI −8 to 30; odds ratio [OR] 1·62, 0·74–3·59; p=0·23). The most frequent grade 3 and 4 toxicities were skin toxicity (15 of 54 patients in group A, and 22 of 55 patients in group B), and neutropenia (13 of 54 patients in group A and 12 of 55 patients in group B). R0 resection was done in 20 (38%) of 53 patients in group A and 16 (30%) of 53 of patients in group B. In a retrospective analysis of response by KRAS status, a partial or complete response was noted in 47 (70%) of 67 patients with KRAS wild-type tumours versus 11 (41%) of 27 patients with KRAS -mutated tumours (OR 3·42, 1·35–8·66; p=0·0080). According to the retrospective review, resectability rates increased from 32% (22 of 68 patients) at baseline to 60% (41 of 68) after chemotherapy (p Interpretation Chemotherapy with cetuximab yields high response rates compared with historical controls, and leads to significantly increased resectability. Funding Merck-Serono, Sanofi-Aventis, and Pfizer.read more
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Surgical Treatment of Metastatic Colorectal Cancer.
Jeffery Chakedis,Carl Schmidt +1 more
TL;DR: Surgical treatment of metastatic colorectal cancer offers a chance for cure or prolonged survival, particularly for those with more favorable prognostic factors and limited tumor burden, and the treatment plan requires multidisciplinary evaluation.
Journal ArticleDOI
Recommendations from the EGAPP Working Group: Can testing of tumor tissue for mutations in EGFR pathway downstream effector genes in patients with metastatic colorectal cancer improve health outcomes by guiding decisions regarding anti-EGFR therapy?
Ned Calonge,Nancy L. Fisher,Alfred O. Berg,Doug Campos-Outcalt,Benjamin Djulbegovic,Theodore G. Ganiats,James E. Haddow,Roger D. Klein,Donald O. Lyman,Kenneth Offit,Stephen G. Pauker,Margaret Piper,Carolyn Sue Richards,Ora L. Strickland,Sean R. Tunis,David L. Veenstra +15 more
TL;DR: There is convincing evidence to recommend clinical use ofKRAS mutation analysis to determine which patients are KRAS mutation positive and therefore unlikely to benefit from these agents before initiation of therapy, for patients with metastatic colorectal cancer who are being considered for treatment with cetuximab or panitumumab.
Journal ArticleDOI
Intraoperative Detection of Disappearing Colorectal Liver Metastases as a Predictor of Residual Disease
Alessandro Ferrero,Serena Langella,Nadia Russolillo,Luca Viganò,Roberto Lo Tesoriere,Lorenzo Capussotti +5 more
TL;DR: Systematic US exploration of the liver leads to increase the intraoperative detection rate of residual liver metastases and the majority of DLMs identified by IOUS presents residual disease at pathological examination and should be treated.
Journal ArticleDOI
Prognostic Significance of a Systemic Inflammatory Response in Patients Undergoing Multimodality Therapy for Advanced Colorectal Cancer
Yasuhiro Inoue,Takashi Iwata,Yoshinaga Okugawa,Aya Kawamoto,Junichiro Hiro,Yuji Toiyama,Koji Tanaka,Keiichi Uchida,Yasuhiko Mohri,Chikao Miki,Masato Kusunoki +10 more
TL;DR: The modified Glasgow Prognostic Score (mGPS) is an independent prognostic indicator of survival in patients undergoing multimodality therapy for advanced CRC, if recorded at a relevant time point.
Journal ArticleDOI
Palliative care and end-stage colorectal cancer management: The surgeon meets the oncologist
TL;DR: The role of colonic resection in this group has been challenged in recent years, as it is not clear whether the resection of primary CRC may imply a further increase in survival, thus justifying surgery-related morbidity/mortality in such a class of short-living patients.
References
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Journal ArticleDOI
New Guidelines to Evaluate the Response to Treatment in Solid Tumors
Patrick Therasse,Susan G. Arbuck,Elizabeth Eisenhauer,Jantien Wanders,Richard Kaplan,Larry Rubinstein,Jaap Verweij,Martine Van Glabbeke,Allan T. van Oosterom,Michaele C. Christian,S. Gwyther +10 more
TL;DR: A model by which a combined assessment of all existing lesions, characterized by target lesions and nontarget lesions, is used to extrapolate an overall response to treatment is proposed, which is largely validated by the Response Evaluation Criteria in Solid Tumors Group and integrated into the present guidelines.
Journal ArticleDOI
Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer
Herbert Hurwitz,Louis Fehrenbacher,William Novotny,Thomas Cartwright,John D. Hainsworth,W. Heim,Jordan Berlin,Ari David Baron,Susan Griffing,Eric Holmgren,Napoleone Ferrara,Gwen Fyfe,Beth Rogers,Robert W. Ross,Fairooz F. Kabbinavar +14 more
TL;DR: The addition of bevacizumab to fluorouracil-based combination chemotherapy results in statistically significant and clinically meaningful improvement in survival among patients with metastatic colorectal cancer.
Journal ArticleDOI
Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer.
David Cunningham,Yves Humblet,Salvatore Siena,David Khayat,Harry Bleiberg,Armando Santoro,D. Bets,M. Mueser,Andreas Harstrick,Chris Verslype,Ian Chau,Eric Van Cutsem +11 more
TL;DR: Cetuximab has clinically significant activity when given alone or in combination with irinotecan in patients with ir inotecans-refractory colorectal cancer.
Journal ArticleDOI
Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer.
Eric Van Cutsem,Claus Henning Köhne,Erika Hitre,J. Zaluski,Chung Rong Chang Chien,A. Makhson,Geert R. D'Haens,Tamás Pintér,Robert Lim,György Bodoky,Jae Kyung Roh,Gunnar Folprecht,Paul Ruff,Christopher Stroh,Sabine Tejpar,Michael Schlichting,Johannes Nippgen,Philippe Rougier +17 more
TL;DR: In this paper, the efficacy of cetuximab plus irinotecan, fluorouracil, and leucovorin (FOLFIRI) as first-line treatment for metastatic colorectal cancer was investigated.
Journal ArticleDOI
Clinical Score for Predicting Recurrence After Hepatic Resection for Metastatic Colorectal Cancer: Analysis of 1001 Consecutive Cases
TL;DR: There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer and studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.
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