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Ayez N, van der Stok EP, de Wilt H, Radema SA, van Hillegersberg R, Roumen RM, Vreugdenhil G, Tanis PJ, Punt CJ, Dejong CH, Jansen RL, Verheul HM, de Jong KP, Hospers GA, Klaase JM, Legdeur MC, van Meerten E, Eskens FA, van der Meer N, van der Holt B, Verhoef C, Grünhagen DJ. Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: the CHARISMA randomized multicenter clinical trial. BMC Cancer 2015; 15:180. [PMID: 25884448 PMCID: PMC4377036 DOI: 10.1186/s12885-015-1199-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/17/2015] [Indexed: 12/12/2022] Open
Abstract
Background Efforts to improve the outcome of liver surgery by combining curative resection with chemotherapy have failed to demonstrate definite overall survival benefit. This may partly be due to the fact that these studies often involve strict inclusion criteria. Consequently, patients with a high risk profile as characterized by Fong’s Clinical Risk Score (CRS) are often underrepresented in these studies. Conceptually, this group of patients might benefit the most from chemotherapy. The present study evaluates the impact of neo-adjuvant chemotherapy in high-risk patients with primary resectable colorectal liver metastases, without extrahepatic disease. Our hypothesis is that adding neo-adjuvant chemotherapy to surgery will provide an improvement in overall survival (OS) in patients with a high-risk profile. Methods/Design CHARISMA is a multicenter, randomized, phase III clinical trial. Patients will be randomized to either surgery alone (standard treatment, arm A) or to 6 cycles of neo-adjuvant oxaliplatin-based chemotherapy, followed by surgery (arm B). Patients must be ≥ 18 years of age with liver metastases of histologically confirmed primary colorectal carcinoma. Patients with extrahepatic metastases are excluded. Liver metastases must be deemed primarily resectable. Only patients with a CRS of 3–5 are eligible. The primary study endpoint is OS. Secondary endpoints are progression free survival (PFS), quality of life, morbidity of resection, treatment response on neo-adjuvant chemotherapy, and whether CEA levels can predict treatment response. Discussion CHARISMA is a multicenter, randomized, phase III clinical trial that will provide an answer to the question if adding neo-adjuvant chemotherapy to surgery will improve OS in a well-defined high-risk patient group with colorectal liver metastases. Trial registration The CHARISMA is registered at European Union Clinical Trials Register (EudraCT), number: 2013-004952-39, and in the “Netherlands national Trial Register (NTR), number: 4893.
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Affiliation(s)
- Ninos Ayez
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
| | - Eric P van der Stok
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
| | - Hans de Wilt
- Department of Surgical Oncology, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands.
| | - Sandra A Radema
- Department of Medical Oncology, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands.
| | | | - Rudi M Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
| | - Gerard Vreugdenhil
- Department of Medical Oncology, Máxima Medical Center, Veldhoven, The Netherlands.
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - Cornelis J Punt
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Cornelis H Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Rob L Jansen
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Henk M Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koert P de Jong
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Geke A Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Marie-Cecile Legdeur
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Esther van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Ferry A Eskens
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Nelly van der Meer
- Clinical Trial Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Bruno van der Holt
- Clinical Trial Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
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