Reviewer: Dr Christopher Booth Date posted: June 21, 2007
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www.OncologyEducation.ca Peri-operative FOLFOX4 chemotherapy and surgery for resectable liver metastases from colorectal cancer Plenary Session ASCO 2007 Authors: B. Nordlinger on behalf of EORTC Intergroup Study 40983 Reviewer: Dr Christopher Booth Date posted: June 21, 2007
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Peri-operative FOLFOX4 chemotherapy and surgery for resectable liver metastases from colorectal cancer Plenary Session ASCO 2007 Authors: B. Nordlinger on behalf of EORTC Intergroup Study 40983. Reviewer: Dr Christopher Booth Date posted: June 21, 2007. Treatment A: - PowerPoint PPT Presentation
Transcript of Reviewer: Dr Christopher Booth Date posted: June 21, 2007
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Peri-operative FOLFOX4 chemotherapy and surgery for resectable liver metastases from colorectal cancer
Plenary Session ASCO 2007
Authors: B. Nordlinger on behalf of EORTC Intergroup Study 40983
Reviewer: Dr Christopher Booth
Date posted: June 21, 2007
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Treatment A:Pre-op: 6 cycles of FOLFOX 4SurgeryPost-op: 6 cycles of FOLFOX 4
Treatment B:Surgery alone
• Potentially resectable liver mets of CRC origin• Up to 4 lesions on CT scan• No other sites of disease• No prior oxaliplatin• ECOG 0-2
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RESULTS
Perioperative
FOLFOX
Surgery
Alonep-value
3-year
PFS (%)
All patients
35.4% 28.1% 0.054
3-year
PFS (%)
All eligible pts
36.2% 28.1% 0.041
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STUDY COMMENTARY
• Pre-op FOLFOX 4 was well tolerated and delivered with >90% dose intensity. One patient did not go to surgery due to chemo-related liver toxicity.
• In pre-op group there was progressive disease in 6.6% of patients (n=12). 4/12 patients were resected.
• 83% of patients in both arms were resected.
• Increased rate of post-operative complications in group that received chemotherapy (25 vs 16%, p=0.04). Post-operative mortality no different (1 pt in chemo arm, 2 pts in surgery alone arm).
• 37% of patients in chemo arm did not receive post-operative FOLFOX.
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BOTTOM LINE FOR CANADIAN MEDICAL ONCOLOGISTS
• This well designed RCT evaluated a question which is commonly encountered in clinical practice for which there have previously been minimal data available (and none with combination chemo).
•Despite the trade-off in post-operative complications, there was a clinically meaningful improvement in PFS.
• ? Will this translate into a an impact in overall survival
• Comparable benefits seen with 5FU/FA (7% DFS benefit at 5 yrs, Portier et al, JCO 2006)
• Other questions which remain unanswered include the optimum timing of peri-operative chemotherapy (peri-op vs post-op alone) and the optimal use of modern systemic agents.
