1
|
Liang C, He Z, Tao Q, Tang X, Jiang L, Tu X, Liu Z, Chen H, Xie F, Zheng Y. From Conversion to Resection for Unresectable Hepatocellular Carcinoma: A Review of the Latest Strategies. J Clin Med 2023; 12:7665. [PMID: 38137734 PMCID: PMC10743667 DOI: 10.3390/jcm12247665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China, accounting for the majority of primary liver cancer cases. Liver resection is the preferred curative method for early-stage HCC. However, up to 80-85% of patients have already missed the opportunity of radical surgery due to tumor advances at the time of consultation. Conversion therapies are a series of medications and treatments for initially inoperable patients. For early-stage unresectable HCC (uHCC) patients, conversion therapies are designed to meet surgical requirements by increasing the volume of the residual liver. Meanwhile, for advanced cases, conversion therapies strive for tumor shrinkage and down-staging, creating the opportunity for liver resection or liver transplantation. This review summarizes the latest advances in conversion therapies and highlights their potential for improving the survival benefit of patients with uHCC.
Collapse
Affiliation(s)
- Chen Liang
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhaoqian He
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Qiang Tao
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiang Tang
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Lingmin Jiang
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xinyue Tu
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zonghao Liu
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hua Chen
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Feihu Xie
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yun Zheng
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (C.L.); (Z.H.)
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| |
Collapse
|
2
|
Mortality of patients with metastatic colorectal cancer who received elective or emergent operation after exposure to bevacizumab: A nationwide database study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:445-451. [PMID: 36208981 DOI: 10.1016/j.ejso.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Treatment guidelines for colorectal cancer (CRC) indicate that surgical intervention within 4 weeks or 8 weeks after bevacizumab therapy might increase the risk of postoperative complications and mortality, especially in patients who received emergent operation. Therefore, we aimed to assess the association between different surgical timings, emergent or elective surgery, and the risk of postoperative mortality. MATERIALS AND METHODS Using the Taiwan National Health Insurance Database and Taiwan Cancer Registry, we identified patients with metastatic colorectal cancer (mCRC) who underwent surgery within 1 year of receiving bevacizumab between January 2010 and December 2017. The primary outcomes were 30-day, 60-day, and in-hospital mortality; the secondary outcomes were hospital stay, 30-day readmission rate, and surgical complications. Multivariate analysis was used to adjust for confounders. RESULTS This study included 2,047 patients. In the multivariate analysis, patients who underwent emergent operation and had higher Charlson scores had a significantly higher mortality rate. Patients with a longer interval to surgery, more cycles of bevacizumab treatment, and distal metastectomy had the opposite result. In subgroup analysis, patients who received emergent operation within 28 days had the highest surgical mortality. CONCLUSIONS The interval to operation among mCRC patients who receive bevacizumab treatment should exceed 4 weeks to avoid additional risk of mortality whether patients receiving elective or emergent operation. Patients who received emergent operation within 28 days of bevcizumab infusion had the highest risk of mortality.
Collapse
|
3
|
Matsuhashi N, Tomita H, Tanaka H, Iwata Y, Matsui S, Imai H, Fukada M, Mizutani C, Takahashi T, Yasufuku I, Suetsugu T, Mori R, Tanaka Y, Okumura N, Futamura M, Yoshida K. Evaluation of histopathological heterogeneity of colorectal cancer liver metastasis sites after preoperative chemotherapy. Mol Clin Oncol 2022; 16:61. [PMID: 35127086 PMCID: PMC8771193 DOI: 10.3892/mco.2022.2494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Patients with liver metastases from colorectal cancer (CRLMs) frequently receive chemotherapy prior to liver resection. Histopathological assessment of the resected specimen can evaluate the response to chemotherapy. The present study analyzed the association between histopathological changes in the primary site and liver metastases. The present study comprised 45 patients with resectable CRLMs at the Surgical Oncology Department of Gifu University School of Medicine (Gifu, Japan) between January 2006 and August 2015. The study included 24 men and 21 women. The primary colonic tumor was located in the right side in 13 (28.9%) patients and the left side in 32 (71.9%) patients. The present study evaluated patients with metastatic colorectal cancer (31/45) after excluding those in whom histopathological heterogeneity between the primary and liver metastasis changed to grade 3 after chemotherapy. The group that underwent hepatectomy after chemotherapy (n=25) was compared with the group that underwent hepatectomy alone (n=6). In 16 (53.3%) out of 25 patients, histopathological heterogeneity of the liver metastasis was lost (P=0.04). In conclusion, chemotherapy appeared to change histopathological heterogeneity. The present study suggested that the histopathological change of intratumoral heterogeneity is reflected by the response to chemotherapy.
Collapse
Affiliation(s)
- Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Hidenori Tanaka
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Yoshinori Iwata
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Satoshi Matsui
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Hisashi Imai
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Masahiro Fukada
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Chika Mizutani
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Itaru Yasufuku
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Tomonari Suetsugu
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Ryutaro Mori
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Naoki Okumura
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Manabu Futamura
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Gifu 501-1194, Japan
| |
Collapse
|
4
|
Larrey D, Meunier L, Valla D, Hillaire S, Hernandez-Gea V, Dutheil D, Plessier A, Bureau C. Drug induced liver injury and vascular liver disease. Clin Res Hepatol Gastroenterol 2020; 44:471-479. [PMID: 32371005 DOI: 10.1016/j.clinre.2020.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Dominique Larrey
- Department of Gastroenterology and Hepatology, Saint-Éloi Hospital, University Hospital of Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
| | - Lucy Meunier
- Department of Gastroenterology and Hepatology, Saint-Éloi Hospital, University Hospital of Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Dominique Valla
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of Hepatology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) Rare-Liver, Clichy, France
| | - Sophie Hillaire
- Department of Internal Medicine, Foch Hospital, 40, rue Worth, 92150 Suresnes, France
| | - Virginia Hernandez-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Health Care Provider of the European Reference Network onRare Liver Disorders (ERN-Liver), Spain
| | - Danielle Dutheil
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Association of patients with vascular liver diseases (AMVF), Department of Hepatology, Beaujon Hospital, 100, boulevard du Général Leclerc, 92118 Clichy, France
| | - Aurélie Plessier
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of Hepatology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) Rare-Liver, Clichy, France
| | - Christophe Bureau
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of Gastroenterology and Hepatology, Rangueil Hospital, University Hospital of Toulouse, 1, avenue du Professeur Jean-Poulhès, 31400 Toulouse, France
| |
Collapse
|
5
|
Valverde A, Ciria R, Caballero-Villarraso J, Aguilar-Melero P, Ferrín G, Ranchal I, Linares C, Herencia C, González-Rubio S, de la Mata M, Naranjo Á, Briceño J. Bevacizumab Allows Preservation of Liver Function and its Regenerative Capacity after Major Hepatectomy. Anticancer Agents Med Chem 2019; 19:1388-1398. [PMID: 31038079 DOI: 10.2174/1871520619666190417162409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/25/2019] [Accepted: 03/26/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Parallel to the safety of liver resections, new chemotherapy drugs have emerged for the control of liver metastases. However, there is unclear evidence about the combination of intensive BVZ-therapy and extended resections. The main aim was to analyse the impact of Bevacizumab (BVZ) in terms of liver safety and tolerability in two experimental models: a basal-toxicity situation and after major hepatectomy. METHODS Eighty male-Wistar rats were grouped as toxicity analysis (sham-operated rats-OS-) and regeneration after- surgery analysis (hepatectomy rats-H-). Eight further subgroups were created according to sacrifice (6- hours-6h- or 24-hours-24h-) and dose (μg) of BVZ (none, 100, 200, 400). Several measurements were performed, including biochemical serum samples, histopathological analysis, cytokines (IL-6, TNF-α, TGF-β), oxidative-stress (GSH/GSSG, ATP), lipid-peroxidation (TBARS) and epidermal and vascular endothelium growth-factors (EGF and VEGF). RESULTS In the toxicity analysis, safe results with BVZ were observed, with no significant differences among the groups. A trend towards a lower oxidative status was observed in the OS 6 h-100, -200 and -400 versus the OS 6 h-none group. Similar results were observed in the hepatectomy model, with stable oxidative-stress-index and IL-6, TNF- α, and TGF- β levels. Despite higher lipid peroxidation status, overall regeneration was preserved. As expected, VEGF was almost undetectable in BVZ-treated groups after resection, but not in the non-resection group. CONCLUSION It was concluded that liver status was not impaired by BVZ even at the high-dose. Similarly, liver regeneration after extended hepatectomy in BVZ-treated animals was well-preserved. Extended liver resections may be encouraged in BVZ-treated patients due to its excellent tolerability and good liver regeneration status.
Collapse
Affiliation(s)
- Amparo Valverde
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC/Reina Sofia Hospital/University of Cordoba, Córdoba, Spain
| | - Rubén Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC/Reina Sofia Hospital/University of Cordoba, Córdoba, Spain
| | - Javier Caballero-Villarraso
- Clinical Analyses Service & Department of Biochemistry and Molecular Biology, IMIBIC/Reina Sofia Hospital/University of Cordoba, Córdoba, Spain
| | | | - Gustavo Ferrín
- Liver Research Unit, IMIBIC/Reina Sofia Hospital/University of Cordoba, Cordoba, Spain
| | - Isidora Ranchal
- Liver Research Unit, IMIBIC/Reina Sofia Hospital/University of Cordoba, Cordoba, Spain
| | - Clara Linares
- Liver Research Unit, IMIBIC/Reina Sofia Hospital/University of Cordoba, Cordoba, Spain
| | - Carmen Herencia
- Liver Research Unit, IMIBIC/Reina Sofia Hospital/University of Cordoba, Cordoba, Spain
| | - Sandra González-Rubio
- Liver Research Unit, IMIBIC/Reina Sofia Hospital/University of Cordoba, Cordoba, Spain
| | - Manuel de la Mata
- Liver Research Unit, IMIBIC/Reina Sofia Hospital/University of Cordoba, Cordoba, Spain
| | - Álvaro Naranjo
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC/Reina Sofia Hospital/University of Cordoba, Córdoba, Spain
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC/Reina Sofia Hospital/University of Cordoba, Córdoba, Spain
| |
Collapse
|
6
|
Clinicopathological characteristics associated with necrosis in pulmonary metastases from colorectal cancer. Virchows Arch 2019; 474:569-575. [DOI: 10.1007/s00428-019-02535-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
|
7
|
Ledys F, Klopfenstein Q, Truntzer C, Arnould L, Vincent J, Bengrine L, Remark R, Boidot R, Ladoire S, Ghiringhelli F, Derangere V. RAS status and neoadjuvant chemotherapy impact CD8+ cells and tumor HLA class I expression in liver metastatic colorectal cancer. J Immunother Cancer 2018; 6:123. [PMID: 30454021 PMCID: PMC6245855 DOI: 10.1186/s40425-018-0438-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022] Open
Abstract
Background T lymphocytes and HLA expression on tumor cell both influence prognostic of localized colorectal cancer, but their role following chemotherapy in patients with liver metastatic colorectal cancer (mCRC) was not addressed. Methods One hundred fourteen patients treated in curative intend of liver mCRC were included in this retrospective study. Patients were either untreated or treated with neoadjuvant therapy containing an anti-EGFR, bevacizumab or oxaliplatin. Immune densities were quantified in the tumor core and in invasive margin of metastases, using Qupath software or a pathologist’s quantification. CD8, NKp46, Foxp3, CD163, HLA, PD-L1 were analyzed and were correlated with progression free survival (PFS) and overall survival (OS) using multivariable Cox proportional hazards models. Results In the whole cohort only a high CD8+ cells infiltrate, a high HLA-I expression and wild-type RAS/RAF status were associated with a better overall survival in both univariate and multivariate model. Moreover, CD8+ cells immune infiltrate at invasive margin combined to HLA expression in cancer cell could increase patient’s outcome prediction. RAS status but not immune cell infiltrate was associated with HLA expression on tumor cells. In comparison to untreated patients, neoadjuvant chemotherapy induced CD8+ cells recruitment and increased PD-L1 staining in immune infiltrates only for WT RAS patients. In this context, anti-EGFR and oxaliplatin based chemotherapy are the most powerful to induce CD8+ cells mobilization within the metastatic site. Conclusions While CD8 infiltrate and HLA expression appear to be prognostic for mCRC, CD8 and PD-L1 infiltrate are enhanced by neoadjuvant chemotherapy in mCRC under RAS status dependence. Electronic supplementary material The online version of this article (10.1186/s40425-018-0438-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Fanny Ledys
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France.,Université de Bourgogne-Franche comté, Faculté des Sciences de Santé, Dijon, France
| | - Quentin Klopfenstein
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France
| | - Caroline Truntzer
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France
| | - Laurent Arnould
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France.,Department of Pathology, Centre Georges-François Leclerc, Dijon, France
| | - Julie Vincent
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Leila Bengrine
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Romain Remark
- Innate Pharma, 117 Avenue de Luminy, Marseille, France
| | - Romain Boidot
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France
| | - Sylvain Ladoire
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France.,Université de Bourgogne-Franche comté, Faculté des Sciences de Santé, Dijon, France.,Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France.,INSERM UMR1231, Dijon, France
| | - Francois Ghiringhelli
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France. .,Université de Bourgogne-Franche comté, Faculté des Sciences de Santé, Dijon, France. .,GIMI Genetic and Immunology Medical Institute, Dijon, France. .,Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France. .,INSERM UMR1231, Dijon, France.
| | - Valentin Derangere
- Cancer Biology Research Platform, Centre Georges-François Leclerc, Dijon, France. .,Université de Bourgogne-Franche comté, Faculté des Sciences de Santé, Dijon, France. .,GIMI Genetic and Immunology Medical Institute, Dijon, France.
| |
Collapse
|
8
|
Raouf S, Bertelli G, Ograbek A, Field P, Tran I. Real-world use of bevacizumab in metastatic colorectal, metastatic breast, advanced ovarian and cervical cancer: a systematic literature review. Future Oncol 2018; 15:543-561. [PMID: 30379088 DOI: 10.2217/fon-2018-0480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM This review aims to assist physicians and payers in assessing the efficacy and safety of bevacizumab in real-world clinical practice by identifying evidence on the comparative effectiveness and safety of bevacizumab in its most frequent indications. Materials & methods: In a systematic review of the published literature, electronic databases (Embase®, MEDLINE® and the Cochrane Library) were searched in May 2016 and updated in January 2017; 20 scientific congresses were searched in 2014-2017. RESULTS Of 61 included publications, 49, eight, four and 0 concerned metastatic colorectal cancer, metastatic breast cancer, advanced ovarian cancer and cervical cancer, respectively. Fifteen publications (metastatic colorectal cancer) reported on factors predictive of response to therapy. CONCLUSION Effectiveness findings from real-world studies broadly supported results from registration studies.
Collapse
Affiliation(s)
- Sherif Raouf
- Department of Oncology - Clinical, Queen's Hospital, Rom Valley Way, Romford, RM7 0AG, UK
| | | | - Agnes Ograbek
- Global Product Development - Medical Affairs Oncology, Roche Products Limited, Hexagon Place, Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| | - Polly Field
- Value Demonstration Practice, PharmaGenesis Oxford Central, 38 St Aldates, Chamberlain House, Oxford, OX1 1BN, UK
| | - Irwin Tran
- Global Access Department, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| |
Collapse
|
9
|
Hubert C, Lucidi V, Weerts J, Dili A, Demetter P, Massart B, Komuta M, Navez J, Reding R, Gigot JF, Sempoux C. Impact of biological agents on the prevalence of chemotherapy associated liver injury (CALI): Multicentric study of patients operated for colorectal liver metastases. Eur J Surg Oncol 2018; 44:1532-1538. [DOI: 10.1016/j.ejso.2018.07.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/27/2018] [Accepted: 07/18/2018] [Indexed: 01/10/2023] Open
|
10
|
A Population-Based Study of Complications After Colorectal Surgery in Patients Who Have Received Bevacizumab. Dis Colon Rectum 2018; 61:306-313. [PMID: 29420426 DOI: 10.1097/dcr.0000000000000966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients receiving Bevacizumab, a vascular endothelial growth factor inhibitor used to treat metastatic colorectal cancer, may be at greater risk of complications after colorectal surgery because of impaired healing. OBJECTIVE The purpose of this study was to describe population-based rates of complications of colorectal surgery after Bevacizumab treatment and evaluate the relationship between time since last treatment and risk of complications. DESIGN This was a population-based retrospective cohort study using administrative and cancer registry data. SETTINGS The study was conducted in Ontario, Canada. PATIENTS Patients with metastatic colorectal cancer receiving Bevacizumab between January 2008 and December 2011 were followed for a year after treatment or until death. MAIN OUTCOME MEASURES Administrative data were used to identify patients who underwent colorectal surgery after initiation of Bevacizumab and to determine whether they experienced a complicated postoperative course. The relationship between time since last Bevacizumab treatment (≤28 d, 29 d to 3 mo, and >3 mo) and risk of postoperative complications was evaluated using logistic regression. RESULTS Of the 2759 patients who received Bevacizumab for the treatment of metastatic colorectal cancer, 265 underwent a colorectal procedure after exposure. The majority had a bowel resection or repair with no stoma (47.5%) and had emergency surgery (61.1%). Overall, 96 (36.2%) had a complicated postoperative course, including 20.4% readmission, 12.5% wound complications, and 7.9% mortality rate within 30 days of surgery. Adjusted multivariate analysis showed no difference in the likelihood of a complicated postoperative course among patients undergoing surgery within 28 days of receiving their last Bevacizumab dose compared with 29 days to 3 months (OR = 1.23 (95% CI, 0.53-2.84), or 3 to 12 months (OR = 0.98 (95% CI, 0.46-2.09) after receiving Bevacizumab. LIMITATIONS Reliance on administrative data to measure complications limited the scope of this study. CONCLUSIONS Patients with metastatic colorectal cancer requiring colorectal surgery after exposure to Bevacizumab experience substantial morbidity and mortality. The risk of complications is not detectably associated with time since exposure. See Video Abstract at http://links.lww.com/DCR/A474.
Collapse
|
11
|
Rahbari NN, Kedrin D, Incio J, Liu H, Ho WW, Nia HT, Edrich CM, Jung K, Daubriac J, Chen I, Heishi T, Martin JD, Huang Y, Maimon N, Reissfelder C, Weitz J, Boucher Y, Clark JW, Grodzinsky AJ, Duda DG, Jain RK, Fukumura D. Anti-VEGF therapy induces ECM remodeling and mechanical barriers to therapy in colorectal cancer liver metastases. Sci Transl Med 2017; 8:360ra135. [PMID: 27733559 DOI: 10.1126/scitranslmed.aaf5219] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022]
Abstract
The survival benefit of anti-vascular endothelial growth factor (VEGF) therapy in metastatic colorectal cancer (mCRC) patients is limited to a few months because of acquired resistance. We show that anti-VEGF therapy induced remodeling of the extracellular matrix with subsequent alteration of the physical properties of colorectal liver metastases. Preoperative treatment with bevacizumab in patients with colorectal liver metastases increased hyaluronic acid (HA) deposition within the tumors. Moreover, in two syngeneic mouse models of CRC metastasis in the liver, we show that anti-VEGF therapy markedly increased the expression of HA and sulfated glycosaminoglycans (sGAGs), without significantly changing collagen deposition. The density of these matrix components correlated with increased tumor stiffness after anti-VEGF therapy. Treatment-induced tumor hypoxia appeared to be the driving force for the remodeling of the extracellular matrix. In preclinical models, we show that enzymatic depletion of HA partially rescued the compromised perfusion in liver mCRCs after anti-VEGF therapy and prolonged survival in combination with anti-VEGF therapy and chemotherapy. These findings suggest that extracellular matrix components such as HA could be a potential therapeutic target for reducing physical barriers to systemic treatments in patients with mCRC who receive anti-VEGF therapy.
Collapse
Affiliation(s)
- Nuh N Rahbari
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
| | - Dmitriy Kedrin
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Joao Incio
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Hao Liu
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - William W Ho
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hadi T Nia
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Christina M Edrich
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Keehoon Jung
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Julien Daubriac
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Ivy Chen
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Takahiro Heishi
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - John D Martin
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Yuhui Huang
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Nir Maimon
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Christoph Reissfelder
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
| | - Jurgen Weitz
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
| | - Yves Boucher
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Jeffrey W Clark
- Department of Hematology/Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Alan J Grodzinsky
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Dan G Duda
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Rakesh K Jain
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | - Dai Fukumura
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| |
Collapse
|
12
|
Zhao ZX, Li X, Liu WD, Liu XZ, Wu SJ, Hu XH. Inhibition of Growth and Metastasis of Tumor in Nude Mice after Intraperitoneal Injection of Bevacizumab. Orthop Surg 2017; 8:234-40. [PMID: 27384733 PMCID: PMC6593177 DOI: 10.1111/os.12236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/19/2016] [Indexed: 01/16/2023] Open
Abstract
Objective To explore the inhibitory effect of bevacizumab, a vascular endothelial growth factor antibody, on angiogenesis in human osteosarcoma of nude mice. Methods Twenty‐one nude mice were inoculated with red fluorescent protein (RFP)‐labeled human osteosarcoma cell line 143B‐RFP, that is, clones that expressed RFP in the cytoplasm, and randomly assigned to one of three groups: G1 (Control group, injected with saline solution); G2 (intraperitoneal bevacizumab 2 mg/kg twice per week) and G3 (intraperitoneal bevacizumab 5 mg/kg, twice per week). The tumor‐bearing mice were examined in a fluorescence light box that was illuminated periodically. The primary tumors were measured by fluorescence imaging weekly and their volumes calculated. Results The mean tumor volumes were significantly smaller in the G3 (186.4 ± 100.8 mm3) than the control group (587.0 ± 406.8 mm3) (P < 0.05) on Day 31, and again significantly smaller in the G3 (677.3 ± 461.9 mm3) than the control group (3162.6 ± 1529.2 mm3) on Day 38 (P < 0.01). The average tumor volume in the G2 group was 493.5 ± 425.4 mm3 on Day 31 and 1870.1 ± 1524.8 mm3 on Day 38. The effect on tumor volume was greater in the G3 than the G2 group. Three mice in the G2 group, four in the G3 group and four in the control group developed lung metastases that were confirmed by pathological examination; these differences were not statistically significant (P < 0.05). Conclusions Bevacizumab exhibits strong antiangiogenesis activity in experimental osteosarcoma in a nude mouse model but does not influence the incidence of lung metastasis. Our findings may have considerable potential for the treatment of osteosarcoma.
Collapse
Affiliation(s)
- Ze-Xue Zhao
- Department of Orthopaedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
| | - Xiang Li
- Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
| | - Wei-Dong Liu
- Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
| | - Xiao-Zhou Liu
- Department of Orthopaedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Su-Jia Wu
- Department of Orthopaedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiao-Hui Hu
- Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
| |
Collapse
|
13
|
Hasselgren K, Malagò M, Vyas S, Campos RR, Brusadin R, Linecker M, Petrowsky H, Clavien PA, Machado MA, Hernandez-Alejandro R, Wanis K, Valter L, Sandström P, Björnsson B. Neoadjuvant chemotherapy does not affect future liver remnant growth and outcomes of associating liver partition and portal vein ligation for staged hepatectomy. Surgery 2017; 161:1255-1265. [PMID: 28081953 DOI: 10.1016/j.surg.2016.11.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/09/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The only potentially curative treatment for patients with colorectal liver metastases is hepatectomy. Associating liver partition and portal vein ligation for staged hepatectomy has emerged as a method of treatment for patients with inadequate future liver remnant. One concern about associating liver partition and portal vein ligation for staged hepatectomy is that preoperative chemotherapy may negatively affect the volume increase of the future liver remnant and outcomes. METHODS This study from the International Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Registry (NCT01924741) includes 442 patients with colorectal liver metastases registered from 2012-2016. Future liver remnant hypertrophy (absolute increase, percent increase, and kinetic growth rate) and clinical outcome were analyzed retrospectively in relation to type and amount of chemotherapy. The analyzed groups included patients with no chemotherapy, 1 regimen of chemotherapy, >1 regimen, and a group that received monoclonal antibodies in addition to chemotherapy. RESULTS Ninety percent of the patients received neoadjuvant oncologic therapy including 42% with 1 regimen of chemotherapy, 44% with monoclonal antibodies, and 4% with >1 regimen. Future liver remnant increased between 74-92% with the largest increase in the group with 1 regimen of chemotherapy. The increase in milliliters was between 241 mL (>1 regimen) and 306 mL (1 regimen). Kinetic growth rate was between 14-18% per week and was greatest for the group with 1 regimen of chemotherapy. No statistical significance was found between the groups with any of the measurements of future liver remnant hypertrophy. CONCLUSION Neoadjuvant chemotherapy, including monoclonal antibodies, does not negatively affect future liver remnant growth. Patients with colorectal liver metastases who might be potential candidates for associating liver partition and portal vein ligation for staged hepatectomy should be considered for neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Kristina Hasselgren
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Massimo Malagò
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, United Kingdom
| | - Soumil Vyas
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, United Kingdom
| | - Ricardo Robles Campos
- Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - Roberto Brusadin
- Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - Michael Linecker
- Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Pierre Alain Clavien
- Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Kerollos Wanis
- Department of Surgery, Western University, London, Ontario, Canada
| | - Lars Valter
- Research and Development Unit in Local Healthcare, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| |
Collapse
|
14
|
Matsushima S, Sato T, Nishiofuku H, Sato Y, Murata S, Kinosada Y, Era S, Inaba Y. Equivalent cross-relaxation rate imaging and diffusion weighted imaging for early prediction of response to bevacizumab-containing treatment in colorectal liver metastases-preliminary study. Clin Imaging 2016; 41:1-6. [PMID: 27721090 DOI: 10.1016/j.clinimag.2016.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/31/2016] [Accepted: 08/22/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate and compare the usefulness of equivalent cross-relaxation rate (ECR) imaging (ECRI) and diffusion-weighted imaging (DWI) in the early prediction of the response of bevacizumab-containing treatments of colorectal liver metastases. METHODS AND MATERIAL Seven patients received bevacizumab-containing treatments for colorectal liver metastases. Serial magnetic resonance imaging was performed to evaluate responses before and 2 weeks after starting chemotherapy. In the ECRI, we adopted the off-resonance technique for preferential saturation of immobile protons to evaluate the ECR values. A single saturation transfer pulse frequency was used at a frequency of 3.5 ppm downfield from the water resonance. In the DWI, the apparent diffusion coefficient (ADC) value commonly used with two b-values was acquired by using diffusion weightings of 0 and 800 s/mm2. The region of interest of the metastatic lesions in the liver was separately measured by ECRI and DWI. Tumor response was assessed by response evaluation criteria in solid tumors criteria 8 weeks after starting chemotherapy. RESULTS In this study, we had four responders and three nonresponders. There was a significant difference in the pretreatment ECR values between the responders and nonresponders (P=.01); there was no significant difference in the ADC values between the two groups. Analysis of the percentage difference between the pretreatment and post-treatment values, termed as percentage change, showed that there were no significant differences in the percentage change of the ADC values between both groups; however, the percentage change in the ECR value was significantly greater for the responders than for the nonresponders (-41.6%±17.1% vs. -12.9%±6.9%, respectively; P=.04). CONCLUSION The pretreatment ECR value and percentage change of the ECR value 2 weeks after starting chemotherapy were useful parameters in the early prediction of response to bevacizumab-containing treatment in colorectal liver metastases.
Collapse
Affiliation(s)
- Shigeru Matsushima
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-0021, Japan.
| | - Takeshi Sato
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Hideyuki Nishiofuku
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-0021, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-0021, Japan
| | - Yasutomi Kinosada
- Department of Biomedical Informatics, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Seiichi Era
- Department of Physiology and Biophysics, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-0021, Japan
| |
Collapse
|
15
|
Use of Bevacizumab in the Management of Potentially Resectable Colorectal Liver Metastases: Safety, Pathologic Assessment and Benefit. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
16
|
A 5-year recurrence-free survivor with over ten colorectal liver metastases undergoing FOLFOX plus bevacizumab followed by two-stage hepatectomy. Surg Case Rep 2016; 1:111. [PMID: 26943435 PMCID: PMC4626468 DOI: 10.1186/s40792-015-0113-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 10/21/2015] [Indexed: 11/10/2022] Open
Abstract
A 62-year-old male was admitted because of lower left abdominal pain and diarrhea. The patient was diagnosed with rectal cancer and multiple liver metastases. First, the laparoscopic Hartmann operation with a D3 lymph node dissection was performed. After five cycles of folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) and bevacizumab, and one additional FOLFOX, the tumor markers dramatically decreased; with carcinoembryonic antigen levels ranging from 1096.3 to 7.6 ng/ml and carbohydrate antigen 19-9 levels ranging from 3248.0 to 42.1 U/ml. Computed tomography showed a bilateral 14 colorectal liver metastases which indicated stable disease by the Response Evaluation Criteria In Solid Tumors (RECIST) criteria and optimal morphologic response. A two-stage hepatectomy was performed to complete a curative resection because of the insufficient remnant liver volume. Five partial hepatic resections in the left liver and the right portal vein ligation were performed during the first operation. Thirty-four days later, a right hepatectomy was successfully performed. Pathologically, there was tumor necrosis in 90 percent of the area of the metastasized liver, and viable cells were detected in only a marginal part of the liver. The patient had an uneventful postoperative course and was discharged fifteen days after the second operation. Uracil-tegafur plus leucovorin was administered for 6 months as an adjuvant chemotherapy treatment. The patient is currently alive and has remained disease-free for more than 5 years. In conclusion, an ideal combination of perioperative chemotherapy and curative resection may provide a chance of long-term survival without recurrence of disease for selected patients with more than ten bilateral colorectal liver metastases.
Collapse
|
17
|
Impact of Bevacizumab on parenchymal damage and functional recovery of the liver in patients with colorectal liver metastases. BMC Cancer 2016; 16:84. [PMID: 26864935 PMCID: PMC4750178 DOI: 10.1186/s12885-016-2095-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 01/28/2016] [Indexed: 01/04/2023] Open
Abstract
Background Little is known about the safety of the anti-VEGF antibody bevacizumab in patients undergoing resection for colorectal liver metastases (CLM). This meta-analysis evaluates the impact of bevacizumab on parenchymal damage and functional recovery in patients undergoing resection for CLM. Methods The Medline, Embase and Cochrane Library were systematically searched for studies on preoperative chemotherapy with and without bevacizumab prior to resection of CLM. Studies that reported histological and/or clinical outcomes were eligible for inclusion. Meta-analyses were performed using a random effects model. Results A total of 18 studies with a total sample size of 2430 patients (1050 patients with bevacizumab) were found. Meta-analyses showed a significant reduction in sinusoidal obstruction syndrome (SOS) (Odds ratio 0.50 [95 % confidence interval 0.37, 0.67]; p < 0.001; I2 = 0 %) and hepatic fibrosis (0.61 [0.4, 0.86]; p = 0.004; I2 = 7 %) after preoperative chemotherapy with bevacizumab. The reduced incidence of posthepatectomy liver failure in patients with bevacizumab treatment just failed to reach statistical significance (0.61 [0.34, 1.07]; p = 0.08 I2 = 6 %). While there was no difference in perioperative morbidity and mortality, the incidence of wound complications was significantly increased in patients who received bevacizumab (1.81 [1.12, 2.91]; p = 0.02 I2 = 4 %). Conclusions The combination of bevacizumab with cytotoxic chemotherapy is safe but increases the incidence of wound complications after resection of CLM. The reduction of SOS and hepatic fibrosis warrant further investigation and may explain the inverse association of bevacizumab administration and posthepatectomy liver failure. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2095-6) contains supplementary material, which is available to authorized users.
Collapse
|
18
|
Parekh M, Kluger MD, Griesemer A, Bentley-Hibbert S. Regenerative liver surgeries: the alphabet soup of emerging techniques. Abdom Radiol (NY) 2016; 41:162-73. [PMID: 26830622 DOI: 10.1007/s00261-015-0606-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
New surgical procedures taking advantage of the regenerative abilities of the liver are being introduced as potential curative therapies to these patients either to provide auxiliary support while the native liver recovers or undergoes hypertrophy. For patients with hepatocellular carcinoma outside of the Milan criteria or bilobar colorectal metastases liver transplantation is not an option. Fulminant hepatic failure can be treated but requires life-long immunosuppression. These complex surgical procedures require high quality and directed imaging.
Collapse
Affiliation(s)
- Maansi Parekh
- Columbia University Medical Center, 622 W, 168 Street, PB 1-301, New York, NY, 10032, USA.
| | - Michael D Kluger
- Columbia University Medical Center, 622 W, 168 Street, PB 1-301, New York, NY, 10032, USA.
| | - Adam Griesemer
- Columbia University Medical Center, 622 W, 168 Street, PB 1-301, New York, NY, 10032, USA.
| | - Stuart Bentley-Hibbert
- Columbia University Medical Center, 622 W, 168 Street, PB 1-301, New York, NY, 10032, USA.
| |
Collapse
|
19
|
Stremitzer S, Stift J, Singh J, Starlinger P, Gruenberger B, Tamandl D, Gruenberger T. Histological response, pattern of tumor destruction and clinical outcome after neoadjuvant chemotherapy including bevacizumab or cetuximab in patients undergoing liver resection for colorectal liver metastases. Eur J Surg Oncol 2015; 41:868-74. [PMID: 25865557 DOI: 10.1016/j.ejso.2015.03.223] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/27/2015] [Accepted: 03/05/2015] [Indexed: 02/07/2023] Open
Abstract
AIM We investigated whether the type of antibody [bevacizumab (bev) or cetuximab (cet)] added to neoadjuvant combination chemotherapy before curative liver resection was associated with histological response, the pattern of tumor destruction and clinical outcome in patients with colorectal liver metastases (CLM). METHODS We investigated 138 patients with KRAS wild-type status (codon 12, 13 and 61) who received neoadjuvant chemotherapy including bev (n = 101) or cet (n = 37). The primary endpoint was histological response. Secondary endpoints were necrosis and fibrosis of metastases, radiological response, recurrence-free survival (RFS) and overall survival (OS). RESULTS Histological response was not significantly different between the two groups (P = 0.19). A significantly higher fraction of patients in the bev group showed necrosis of the metastases of ≥ 50% (P < 0.001), while a higher fraction of patients in the cet group showed fibrosis of ≥ 40% (P = 0.030). Radiological response was not significantly different (P = 0.17). Median RFS was significantly shorter in the cet group in univariable analysis (HR 1.59 (95% CI 1.00, 2.51), P = 0.049), but this difference did not remain significant in multivariable analysis (P = 0.45). The 3-year OS rate was not significantly different (P = 0.73). CONCLUSIONS The addition of bevacizumab to combination chemotherapy showed more necrosis but less fibrosis of metastases compared to cetuximab and a trend towards higher histological and radiological response and longer RFS. Further investigations of biological tumor characteristics are required to individualize treatment combinations.
Collapse
Affiliation(s)
- S Stremitzer
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - J Stift
- Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria
| | - J Singh
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - P Starlinger
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - B Gruenberger
- Department of Internal Medicine, St. John of God's Hospital, Vienna, Austria
| | - D Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - T Gruenberger
- Department of Surgery I, Rudolfstiftung Hospital, Vienna, Austria.
| |
Collapse
|
20
|
Clark ME, Smith RR. Liver-directed therapies in metastatic colorectal cancer. J Gastrointest Oncol 2014; 5:374-87. [PMID: 25276410 DOI: 10.3978/j.issn.2078-6891.2014.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/11/2014] [Indexed: 12/19/2022] Open
Abstract
Colorectal cancer (CRC) is a major health concern in the United States (US) with over 140,000 new cases diagnosed in 2012. The most common site for CRC metastases is the liver. Hepatic resection is the treatment of choice for colorectal liver metastases (CLM), with a 5-year survival rate ranging from 35% to 58%. Unfortunately, only about 20% of patients are eligible for resection. There are a number of options for extending resection to more advanced patients including systemic chemotherapy, portal vein embolization (PVE), two stage hepatectomy, ablation and hepatic artery infusion (HAI). There are few phase III trials comparing these treatment modalities, and choosing the right treatment is patient dependent. Treating hepatic metastases requires a multidisciplinary approach and knowledge of all treatment options as there continues to be advances in management of CLM. If a patient can undergo a treatment modality in order to increase their potential for future resection this should be the primary goal. If the patient is still deemed unresectable then treatments that lengthen disease-free and overall-survival should be pursued. These include chemotherapy, ablation, HAI, chemoembolization, radioembolization (RE) and stereotactic radiotherapy.
Collapse
Affiliation(s)
- Margaret E Clark
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA
| | - Richard R Smith
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA
| |
Collapse
|
21
|
Giakoustidis A, Neofytou K, Khan A, Mudan S. Addition of bevacizumab to preoperative chemotherapy for colorectal liver metastases does not increase perioperative morbidity and mortality. Hepat Oncol 2014; 1:363-375. [PMID: 30190972 PMCID: PMC6095412 DOI: 10.2217/hep.14.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Patients with colorectal liver metastases (CRLM) benefit from liver resection. Bevacizumab is commonly used in these patients resulting in a greater number of patients receiving an operation for a potentially curative liver resection, with initially unresectable liver metastases. Our purpose was to evaluate the effect of preoperative bevacizumab administration on perioperative complications in patients undergoing hepatic resection for CRLM. METHODS A retrospective analysis of patients undergoing hepatic resection for CRLM who received only neoadjuvant chemotherapy (chemotherapy group, n = 133), or neoadjuvant chemotherapy and bevacizumab (chemotherapy and bevacizumab group, n = 103). We compared surgical characteristics, perioperative complications and postoperative liver function. RESULTS The type of liver resection (minor vs major liver resection) was comparable in the two groups (major liver resection 52.6 vs 62.1%, p = 0.144). The addition of bevacizumab to preoperative chemotherapy does not affect the frequency (chemotherapy group vs chemotherapy and bevacizumab group, 35.3 vs 38.8%, p = 0.581), severity (major complications, 20.3 vs 19.4%, p = 0.487) and type of perioperative complications. Preoperative administration of bevacizumab was associated with a higher peak of postoperative alanine aminotransferase levels but did not affect functional recovery of the liver. CONCLUSION Neoadjuvant administration of bevacizumab was not associated with an increased risk of postoperative complications after hepatic resection and did not affect the liver's functional recovery. Patients receiving more than eight cycles of bevacizumab are at an increased risk to develop perioperative complications.
Collapse
Affiliation(s)
| | - Kyriakos Neofytou
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Aamir Khan
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Satvinder Mudan
- Department of Surgery, The London Clinic, 116 Harley Street, London, W1G 7JL, UK
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, W2 1PG, UK
| |
Collapse
|
22
|
Comment on 'Histopathologic evaluation of liver metastases from colorectal cancer in patients treated with FOLFOXIRI plus bevacizumab'. Br J Cancer 2013; 109:3127-9. [PMID: 24157831 PMCID: PMC3859938 DOI: 10.1038/bjc.2013.651] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
23
|
Cercek A, D’Angelica M, Power D, Capanu M, Gewirtz A, Patel D, Allen P, Fong Y, DeMatteo RP, Jarnagin WR, Kemeny NE. Floxuridine Hepatic Arterial Infusion Associated Biliary Toxicity Is Increased by Concurrent Administration of Systemic Bevacizumab. Ann Surg Oncol 2013; 21:479-86. [DOI: 10.1245/s10434-013-3275-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Indexed: 12/23/2022]
|
24
|
Li-Chang HH, Driman DK. Evaluating necrosis and chemotherapy response in colorectal cancer liver metastases. Comment on Knijnet al. (2013). Histopathology 2013; 63:294-5. [DOI: 10.1111/his.12146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hector H Li-Chang
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto; ON; Canada
| | - David K Driman
- Department of Pathology; Western University; London; ON; Canada
| |
Collapse
|
25
|
Haraldsdottir S, Wu C, Bloomston M, Goldberg RM. What is the optimal neo-adjuvant treatment for liver metastasis? Ther Adv Med Oncol 2013; 5:221-34. [PMID: 23858331 DOI: 10.1177/1758834013485111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Colorectal cancer is the third most common cancer in the Western population and has a 5-year overall survival of 5-10% when metastatic. Approximately 30% of the patients with metastatic colorectal cancer have limited disease apparently isolated to the liver and, if this can be resected, the 5-year overall survival is improved to 30-60%. Therefore, it is important to identify patients who have both resectable disease and those with initially unresectable tumors who can potentially be downsized with chemotherapy to allow resection. First-line doublet chemotherapy regimens lead to response rates of 50-60%, triplet chemotherapy regimens may result in a response rate of up to 70%, and biological agents may add to responses or induce morphologic changes that facilitate disease resection. Surgical advances in recent years have also increased resectability rates and have challenged prior rules of resectability. Local therapies including ablation and radiation, often performed in conjunction with resection, may further aid in control of disease. The aim of this article is to focus on the role of neoadjuvant therapy in the treatment of colorectal liver metastases.
Collapse
Affiliation(s)
- Sigurdis Haraldsdottir
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | | |
Collapse
|
26
|
Loupakis F, Schirripa M, Caparello C, Funel N, Pollina L, Vasile E, Cremolini C, Salvatore L, Morvillo M, Antoniotti C, Marmorino F, Masi G, Falcone A. Histopathologic evaluation of liver metastases from colorectal cancer in patients treated with FOLFOXIRI plus bevacizumab. Br J Cancer 2013; 108:2549-56. [PMID: 23703247 PMCID: PMC3694238 DOI: 10.1038/bjc.2013.245] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The FOLFOXIRI regimen produces a high rate of radiological and histopathological responses. Bevacizumab added to chemotherapy showed an improvement in pathological response and necrosis of colorectal liver metastases (CLMs). FOLFOXIRI plus bevacizumab produced promising early clinical results and is under investigation in several randomised trials, although no data are currently available on its effects on response of CLMs and on liver toxicities. METHODS Starting from 499 patients enrolled in first-line phase II/III trials, we selected on the basis of tissue sample availability 18 patients treated with FOLFOXIRI/XELOXIRI and 24 patients treated with FOLFOXIRI plus bevacizumab who underwent secondary resection of CLMs. The 28 untreated patients who underwent primary resection of CLMs were included as control group. Responses of CLMs and chemotherapy-induced toxicities were assessed. RESULTS Among the patients, 63% of those treated with FOLFOXIRI plus bevacizumab, as compared with 28% of those treated with only FOLFOXIRI/XELOXIRI, showed a histopathological response (P=0.033). In the two groups, 52% and 12.5%, respectively, showed necrosis ≥50% (P=0.017). The incidence of liver toxicities was not significantly increased in patients treated with FOLFOXIRI plus bevacizumab. CONCLUSION The addition of bevacizumab to FOLFOXIRI produces high rates of pathologic responses and necrosis of CLM without increasing liver toxicity.
Collapse
Affiliation(s)
- F Loupakis
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, via Roma 57, 56126 Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Stein A, Schmoll HJ. Systemic treatment of liver metastases from colorectal cancer. Ther Adv Med Oncol 2013; 5:193-203. [PMID: 23634197 PMCID: PMC3630480 DOI: 10.1177/1758834012473347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients presenting with synchronous or metachronous colorectal cancer liver metastases (CLM) should be evaluated for multimodal management with curative intent. Preoperative systemic chemotherapy shows beneficial impact on adjuvant progression-free survival and also borderline on overall survival, without significantly increasing initially R0 resectable patients postoperative complication rates. Postoperative chemotherapy recommended based on the perioperative trial experience for those patients achieving at least stable disease during preoperative chemotherapy, or based on the adjuvant trials for patients receiving upfront resection. 'Borderline' resectable CLM, preoperative chemotherapy plays an important role in both in achievement of a resectable status and improvement of prognosis. Recent 4 drug combinations demonstrated response rates up to 80% even for advanced disease and are thus promising regimens for further evaluation in patients with resectable or unresectable liver-limited (+/- lung) disease.
Collapse
Affiliation(s)
- Alexander Stein
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Centre, University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
28
|
Bevacizumab treatment before resection of colorectal liver metastases: safety, recovery of liver function, pathologic assessment. Pathol Oncol Res 2013; 19:501-8. [PMID: 23420304 DOI: 10.1007/s12253-013-9608-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 02/04/2013] [Indexed: 12/27/2022]
Abstract
Patients with metastatic colorectal cancer receive chemotherapy prior liver resection more and more frequently. This preoperative treatment has many effects which have to be analysed, like the safety of liver resection, toxicity, tissue regeneration, radiological and pathological response and survival data. The aim of the study was to evaluate the safety of bevacizumab containing preoperative chemotherapy and functional recovery of the liver after resection for colorectal liver metastases (CLM) and to analyse radiological and pathological data. Data of three groups of 120 consecutive patients-(1) CTX + BV: cytotoxic chemotherapy + bevacizumab, (2) CTX: cytotoxic chemotherapy, (3) NC: no treatment before liver resection-were analysed. Postoperative liver function and complications were compared, clinical, radiological and pathological data were evaluated. Between 01.12.2006 and 31.12.2010 41 resections was performed after chemotherapy + bevacizumab (CTX + BV) and 27 resections was performed after preoperative chemotherapy without bevacizumab (CTX). There were 60 hepatic resections in this period without neoadjuvant treatment (NC). 8 patients had repeated resections. The postoperative complication rate was 40 % but there was no statistical difference between the groups (P = 0.72). Only the type of resection was associated with a significantly higher complication rate (p = 0.03). The subgroup of patients, who received irinotecan had a higher complication rate in the CTX group than in the BV + CTX group (55 % vs 41 %). Preoperative administration of bevacizumab was associated with higher peak postoperative AST, ALT levels but did not affect functional recovery of the liver. The RECIST system was not able to predict the outcome after chemotherapy in every patient and in many cases this system overestimated the effect of chemotherapy. On histopathological examination the presence of necrosis was not associated with chemotherapy or pathological response. Use of chemotherapy before hepatic resection of CLM was not associated with a significant increase in complication rates. The functional recovery of the liver was not affected by the preoperative administration of chemotherapy. The use of combined neoadjuvant chemotherapy is safe before hepatic resection.
Collapse
|
29
|
Li DB, Ye F, Wu XR, Wu LP, Chen JX, Li B, Zhou YM. Preoperative administration of bevacizumab is safe for patients with colorectal liver metastases. World J Gastroenterol 2013; 19:761-768. [PMID: 23431050 PMCID: PMC3574604 DOI: 10.3748/wjg.v19.i5.761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 11/05/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the impact of preoperative neoadjuvant bevacizumab (Bev) on the outcome of patients undergoing resection for colorectal liver metastases (CLM).
METHODS: Eligible trials were identified from Medline, Embase, Ovid, and the Cochrane database. The data were analyzed with fixed-effects or random-effects models using Review Manager version 5.0.
RESULTS: Thirteen nonrandomized studies with a total of 1431 participants were suitable for meta-analysis. There was no difference in overall morbidity and severe complications between the Bev + group and Bev - group (43.3% vs 36.8%, P = 0.06; 17.1% vs 11.4%, P = 0.07, respectively). Bev-related complications including wound and thromboembolic/bleeding events were also similar in the Bev + and Bev - groups (14.4% vs 8.1%, P = 0.21; 4.1% vs 3.8%, P = 0.98, respectively). The incidence and severity of sinusoidal dilation were lower in patients treated with Bev than in patients treated without Bev (43.3% vs 63.7%, P < 0.001; 16.8% vs 46.5%, P < 0.00, respectively).
CONCLUSION: Bev can be safely administered before hepatic resection in patients with CLM, and has a protective effect against hepatic injury in patients treated with oxaliplatin chemotherapy.
Collapse
|
30
|
Voorthuizen TV, van Gulik TM, Punt CJA. Defining resectability of colorectal liver metastases: how and why? COLORECTAL CANCER 2013. [DOI: 10.2217/crc.12.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SUMMARY Treatment outcome in metastatic colorectal carcinoma has improved because of advancements in medical therapy and increased use of liver resections. In primary nonresectable disease, prognosis improves when a secondary resection is performed after successful downsizing by neoadjuvant systemic therapy. Which patient groups may profit from a secondary liver resection and which neoadjuvant systemic therapy has the optimal chance of conversion to resectability has not been defined because various patient groups were selected in different studies and there is a lack of consensus on resectability. This invalidates cross-study comparisons of resection rates and survival rates. Prospective trials in which secondary resection rate is a predefined end point are needed and will allow more insight into this topic.
Collapse
Affiliation(s)
- Theo van Voorthuizen
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Cornelis JA Punt
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Schwarz RE, Berlin JD, Lenz HJ, Nordlinger B, Rubbia-Brandt L, Choti MA. Systemic cytotoxic and biological therapies of colorectal liver metastases: expert consensus statement. HPB (Oxford) 2013; 15:106-15. [PMID: 23297721 PMCID: PMC3719916 DOI: 10.1111/j.1477-2574.2012.00558.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/29/2012] [Indexed: 12/12/2022]
Abstract
Systemic therapy for colorectal cancer liver metastases (CRLM) has undergone significant development in the past 15 years. Therapy regimens consisting of combinations of cytotoxic chemotherapeutic agents have demonstrated greater efficacy and contributed to a significant survival improvement. As the majority of patients who undergo resection for liver-only CRLM are at risk of disease recurrence and cancer-related death, combining resection with systemic therapy appears sensible. However, trial-based evidence is sparse to support this concept. Peri-operative FOLFOX has demonstrated a progression-free survival benefit in a single Phase III trial; the safety of chemotherapy and subsequent operations was acceptable and only a few patients showed initial progression. Chemotherapy-associated liver injury (CALI), including sinusoidal obstruction syndrome and steatohepatitis, has been observed after cytotoxic therapy, and should have implications for chemotherapy plans prior to hepatectomy. In general, pre-operative chemotherapy should not extend beyond 3 months. For patients with unresectable liver-only CRLM, a response to chemotherapy could establish resectability and should be considered an initial treatment goal. In patients with unresectable CRLM, oxaliplatin- or irinotecan-containing combinations represent the standard options, although single-agent choices may be appropriate for individual patients. The addition of bevacizumab carries the potential for a greater response and possibly for reduced CALI risks. In tumours without K-ras mutations, anti-epidermal growth factor receptor (EGFR) agents are also reasonable choices for a greater response and improved survival outcomes. It is crucial that all systemic CRLM treatment decisions include proper definitions of treatment goals and endpoints, and are derived based on appropriate multidisciplinary considerations for other potentially applicable local or regional modalities.
Collapse
Affiliation(s)
| | - Jordan D Berlin
- Department of Medicine, Vanderbilt University Medical CenterNashville, TN
| | - Heinz J Lenz
- Department of Medicine, Keck School of Medicine of USCLos Angeles, CA, USA
| | - Bernard Nordlinger
- Department of Surgery, Hôpital Ambroise ParéBoulogne,Université Versailles Saint Quentin en YvelinesVersailles, France
| | - Laura Rubbia-Brandt
- Department of Pathology, University Hospital of Geneva (HUG)Geneva, Switzerland
| | - Michael A Choti
- Department of Surgery, Johns Hopkins UniversityBaltimore, MD, USA
| |
Collapse
|
32
|
Volumetric analysis of remnant liver regeneration after major hepatectomy in bevacizumab-treated patients: a case-matched study in 82 patients. Ann Surg 2013; 256:755-61; discussion 761-2. [PMID: 23095619 DOI: 10.1097/sla.0b013e31827381ca] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective was to determine the liver regeneration capacity and morbidity and mortality rates after major hepatectomy for colorectal metastases in patients having undergone bevacizumab-based chemotherapy (bev+). PATIENTS AND METHODS Between 2006 and 2011, 41 patients underwent major hepatectomy within 3 months of bevacizumab and were matched with 41 patients operated on following systemic chemotherapy without bevacizumab (bev-). The matching criteria were the following: number of courses of chemotherapy, chemotherapy-free interval, age, and type of hepatectomy. After measurements of remnant liver volume (RLV) preoperatively and at 1 month (RLV1M), volumetric gain was calculated as absolute (RLV1M-RLV) or relative regeneration [(RLV1M-RLV/RLV)]. Ninety-day morbidity was rated according to the Clavien-Dindo classification. RESULTS There were 21 right, 9 extended right, and 11 left hepatectomies in each group. Groups were comparable in terms of matching criteria, body mass index, American Society of Anesthesiologists score, and RLV. No mortalities were observed. There were no intergroup differences in overall morbidity (56% in bev+ vs 34.1%; P = 0.075) or postoperative liver failure. A severe complication occurred in 5 bev+ (4 eviscerations) and 4 bev- (bile leakages) (P = 0.95). The median hospital stay was similar in both groups as were the degrees of absolute and relative liver regeneration (143% in bev+ vs 114%; P = 0.20). Liver regeneration was not influenced by the type of hepatectomy, the number of courses of chemotherapy, or age more than 65 years. CONCLUSIONS In a methodologically robust trial in the largest cohort reported up to date, bevacizumab did not impair liver regeneration after major hepatectomy-even in elderly patients or those with high exposure to chemotherapy.
Collapse
|
33
|
Cauchy F, Faivre S, Belghiti J. Surgical results after downstaging of initially marginal or non-resectable liver metastases. Dig Dis 2012. [PMID: 23207947 DOI: 10.1159/000342048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Surgery remains the best curative treatment for resectable patients with colorectal liver metastases. In patients initially considered unresectable, both refinements in surgical technique using portal vein occlusion or two-step resections and increased efficiency of chemotherapy regimen with the adjunction of antiangiogenics now allow secondary resection. Recent evidence suggests almost identical long-term survival in case of secondary downstaged lesions advocating an aggressive approach. However, these data lie on disparate and nonconsensual criteria for unresectability, which often do not gather technical and oncologic components together. Furthermore, both impaired general status and damaged underlying parenchyma as a consequence of prolonged chemotherapy to achieve resectability as well as the technical challenge required to perform adequate carcinologic resection could increase the operative risk in such patients. In our experience, a subgroup of slow chemo-responding initially unresectable patients who required preoperative liver volume modulation after ≥ 12 cycles of chemotherapy to achieve sufficient response experienced dramatically high operative risk which jeopardized postoperative chemotherapy and subsequently put these patients at increased risk of recurrence. Whether all patients preoperatively amenable to surgery using intensive chemotherapy and complex surgical strategy actually benefit from such an aggressive approach is a matter of ongoing debate, which needs a reappraisal.
Collapse
Affiliation(s)
- F Cauchy
- Department of Hepatobiliopancreatic Surgery, AP-HP, Beaujon Hospital and University Paris 7 Denis Diderot, Clichy, France
| | | | | |
Collapse
|
34
|
Fornaro L, Masi G, Caparello C, Vivaldi C, Falcone A. Resectable liver metastases from colorectal cancer: where we are now and where do we go from here? COLORECTAL CANCER 2012. [DOI: 10.2217/crc.12.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Liver metastases from colorectal cancer represent a peculiar clinical scenario in everyday practice, since treatment should achieve long-term survival or even a cure in selected patients. Presentation may vary between single cases, ranging from easily resectable lesions to more advanced metastatic spreading for which surgery can only be considered after major tumor shrinkage. For resectable liver metastases, surgery remains the essential step in the curative approach to the disease, even though different ablative procedures may be considered as valuable alternatives in certain subsets. Postoperative or perioperative chemotherapy may further improve long-term outcome, even though treatment benefits and harms related to liver toxicity should be carefully balanced in each patient. A comprehensive multidisciplinary assessment of patient- and tumor-related features remains the key to complement the clinical aspects with the biological characterization in the framework of a personalized therapeutic approach.
Collapse
Affiliation(s)
- Lorenzo Fornaro
- Istituto di Scienze della Vita, Scuola Superiore di Studi Universitari e di Perfezionamento Sant’Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
| | - Gianluca Masi
- UO Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Chiara Caparello
- UO Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Caterina Vivaldi
- UO Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Alfredo Falcone
- UO Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie in Medicina, Università di Pisa, Via Roma 55, 56126 Pisa, Italy
| |
Collapse
|
35
|
Cremolini C, Loupakis F, Antoniotti C, Salvatore L, Schirripa M, Fornaro L, Masi G, Falcone A. Upfront Chemotherapy Regimens in Unresectable Disease: One, Two, or Three Cytotoxics? CURRENT COLORECTAL CANCER REPORTS 2012. [DOI: 10.1007/s11888-012-0128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
Eveno C, Le Henaff C, Audollent R, Soyer P, Rampanou A, Nemeth J, Brouland JP, Dupuy E, Pocard M, Bonnin P. Tumor and non-tumor liver angiogenesis is traced and evaluated by hepatic arterial ultrasound in murine models. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1195-1204. [PMID: 22542260 DOI: 10.1016/j.ultrasmedbio.2012.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/22/2012] [Accepted: 03/04/2012] [Indexed: 05/31/2023]
Abstract
We studied the relationships between hepatic and mesenteric mean blood-flow velocities (mBFVs) measured by ultrasound imaging and (1) downstream tumor angiogenesis during liver metastasis induced by spleen injection of LS174 human colon cells overexpressing the antiangiogenic Netrin4 (LS174-NT4) or not (LS174-WT) and (2) downstream normal angiogenesis during hepatic regeneration after 50% hepatectomy. Liver volume and mBFVs were measured before and after surgery, at day 30 in the first model and at days 2, 7 and 16 in the second model. LS174-NT-4 vs. LS174-WT mice presented fewer metastases (25% vs. 90%, p < 0.001) and decreased hepatic mBFVs (16.5 ± 0.8 vs. 21.8 ± 1.4 cm s(-1), p < 0.01), without difference in mesenteric mBFVs. After partial hepatectomy, hepatic and mesenteric mBFVs increased at day 7, from 12.4 ± 1.7 and 11.8 ± 2.6 to 19.1 ± 1.8 and 17.5 ± 2.4 cm s(-1), respectively, (p < 0.01) then returned to baseline as liver volume. Duplex Doppler ultrasonography reliably assesses normal or tumor angiogenesis and may provide follow-up functional evaluation.
Collapse
Affiliation(s)
- Clarisse Eveno
- Université Paris-Diderot, Sorbonne Paris Cité, INSERM, UMR-S 965, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
The resection of liver metastases offers the option of long-term survival for patients with colorectal carcinoma. With regard to resectability three clinical situations can be identified: patients with resectable liver metastases, those with potentially resectable liver metastases and patients with disseminated metastatic disease. Patients with potentially resectable liver metastases should be treated with regimens with high response rates. According to a metaanalysis patients with resectable liver metastases have a better disease-free survival with the combination of resection and chemotherapy. If neoadjuvant therapy is planned in resectable patients the FOLFOX regimen is the schedule with the highest level of evidence. In potentially resectable liver metastases the regimens FOLFIRI/cetuximab and FOLFOXIRI have demonstrated higher response and resection rates in phase III trials. During neoadjuvant therapy resectability should be regularly reevaluated. Operations should be planned as soon as resectability is achieved because a longer therapy will increase morbidity and because of uncertainty over the approach to patients with complete remission.
Collapse
Affiliation(s)
- G Folprecht
- Universitätskrebszentrum/Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | | |
Collapse
|
38
|
|
39
|
Cucchetti A, Ercolani G, Cescon M, Di Gioia P, Peri E, Brandi G, Pellegrini S, Pinna AD. Safety of hepatic resection for colorectal metastases in the era of neo-adjuvant chemotherapy. Langenbecks Arch Surg 2011; 397:397-405. [PMID: 22198370 DOI: 10.1007/s00423-011-0894-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/08/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE The relationship between neo-adjuvant chemotherapy prior to hepatectomy in patients with resectable colorectal liver metastases and post-operative morbidity still has to be clarified. METHODS Data from 242 patients undergoing hepatectomy for colorectal liver metastases, judged resectable at first observation, were reviewed and their clinical outcome was related to neo-adjuvant chemotherapy (125 patients). Selection biases were outlined and properly handled by means of propensity score analysis. RESULTS Post-operative death was 1.2% and morbidity 40.9%. Pre-operative chemotherapy was only apparently related to higher morbidity (P = 0.021): multivariate analysis identified extension of hepatectomy and intra-operative blood loss as independent prognostic variables (P < 0.05). Patients receiving and not receiving neo-adjuvant chemotherapy were significantly different for several covariates, including extension of hepatectomy (P = 0.049). After propensity score adjustment, 94 patients were identified as having similar covariate distribution (standardized differences <|0.1|) except for neo-adjuvant treatment (47 patients for each group). In this matched sample, mortality was similar and post-operative complications were only slightly higher (hazard ratio = 1.38) in treated patients. A significantly higher need for fluid replacement was only observed in patients receiving neo-adjuvant chemotherapy (P = 0.038). CONCLUSIONS Neo-adjuvant chemotherapy showed a limited role in determining post-operative morbidity after hepatic resection and did not modify mortality.
Collapse
Affiliation(s)
- Alessandro Cucchetti
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Bibeau F, Rivière B, Boissière F, Jourdan MF, Bodin X, Perrault V, Cantos C, Lavaill R, Ychou M, Quenet F, Terris B. [Management of colorectal liver metastases after induction treatment. The pathologist's role in 2011]. Ann Pathol 2011; 31:427-32. [PMID: 22172115 DOI: 10.1016/j.annpat.2011.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 10/10/2011] [Indexed: 11/29/2022]
Abstract
The management of colorectal liver metastases has been improved these last years. The efficacy of chemotherapy regimens and targeted therapies has led to a better prognosis. It has also allowed the resection of metastases initially unresectable. In this setting, the pathologist plays a major role. He is involved in the gross examination, in order to perform an adequate sampling of the lesions. He is also involved at the morphological level, for the assessment of the pathological response, which is now recognized as a prognostic factor and a marker of sensitivity or resistance to a given treatment. Moreover, the determination of predictive markers of response or resistance to induction treatments will constitute a supplementary and major challenge for the pathologist.
Collapse
Affiliation(s)
- Frédéric Bibeau
- Service de pathologie, CRLC C Val d'Aurelle, Montpellier cedex, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Chua TC, Saxena A, Liauw W, Chu F, Morris DL. Hepatectomy and resection of concomitant extrahepatic disease for colorectal liver metastases--a systematic review. Eur J Cancer 2011; 48:1757-65. [PMID: 22153217 DOI: 10.1016/j.ejca.2011.10.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/04/2011] [Accepted: 10/24/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent data suggest that hepatectomy for patients with colorectal liver metastases (CLM) with concomitant extrahepatic disease (EHD) achieve encouraging survival result. The authors examine the clinical efficacy of this treatment approach through a systematic review of the published literature. METHODS Electronic search of the MEDLINE and PubMed databases (January 2000 to January 2011) to identify studies reporting outcomes of hepatectomy for CLM with resection of EHD was undertaken. Two reviewers independently appraised each study using a predetermined protocol. Clinical efficacy was synthesised through a narrative review with full tabulation of results of all included studies. RESULTS Twenty-two studies were examined. This comprised 1142 patients. The median disease-free survival was 12 (range, 4-22) months, median overall survival was 30 (range, 14-44) months and median 5-year survival rate was 19% (range, 0-42%). Median 5-year survival of patients with R0 hepatectomy with resection of EHD was 25% (range, 19-36%). Survival based on site of EHD include lung; median survival (M/S) was 41 (range, 32-46) months, porto-caval lymph node; M/S was 25 (range, 19-48) months, peritoneal metastases; M/S was 25 (range, 18-32) months. CONCLUSION In the era of effective systemic therapies, surgical resection of CLM and concomitant EHD in carefully selected patients may achieve survival results superior to non-surgically treated patients. This treatment strategy may be considered appropriate especially when a R0 hepatectomy and complete resection of EHD may be achieved.
Collapse
Affiliation(s)
- Terence C Chua
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, University of New South Wales, St George Hospital, Kogarah, NSW 2217, Sydney, Australia
| | | | | | | | | |
Collapse
|
42
|
|