Evolution of neoadjuvant therapy for extended hepatic metastases—have we reached our (non‐resectable) limit?

Adam, René; Hoti, Emir; Bredt, Luis Cesar

doi:10.1002/jso.21727

Cited by 34 publications

(35 citation statements)

References 94 publications

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“…Bismuth et al [13] reported that 17% of patients with NRLM were eligible for hepatectomy after treatment with FOLFOX, offering benefit in survival. Recent reports show that the S14 Tech Coloproctol (2011) 15 (Suppl 1):S13-S16 usage of FOLFOX, FOLFIRI or even FOLFIRINOX combined with biologic agents greatly improves the response rates, and almost 30% of patients with NRLM are eligible for resection [16]. There is much debate about the extent of liver resection needed in patients who have responded to preoperative chemotherapy or ever ''cured''.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

“…It is indicated when the FLR volume after resection is below the cutoff values of 20% for normal liver parenchyma and 30-40% in patients underwent preoperative chemotherapy or have abnormal liver parenchyma (usually patients with cirrhosis) [2,4,5]. A possible complication of PVE is tumor progression in the FLR as a result of the induced liver hypertrophy when bilobar CRLM are present [2,16,17].…”

Section: Portal Vein Embolizationmentioning

confidence: 99%

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General principles of hepatectomy in colorectal liver metastases

Maroulis

Karavias

2011

Tech Coloproctol

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Hepatic resection for colorectal liver metastases remains the only therapeutic option that improves long-term survival and offers potential cure. By conventional resectability criteria, only a limited number of patients with metastatic disease can be subjected to surgical intervention. In the past decade, better understanding of the natural history of the disease, the introduction of new chemotherapy agents and the advances in surgical techniques have led to more patients being eligible for surgery. Neoadjuvant chemotherapy can reduce the size of the metastases, allowing operation on patients who were previously considered inoperable. Major resections can nowadays be safely performed with the development of new less-invasive techniques and with the use of supplementary tools like ablation techniques. Using portal vein embolization to induce hypertrophy of future liver remnant and combining it with two-staged hepatectomy allow more patients with advanced disease to undergo potentially curative surgery. Careful selection of patients and aggressive surgery in experienced centers improve survival rates.

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Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

Section: Portal Vein Embolizationmentioning

confidence: 99%

General principles of hepatectomy in colorectal liver metastases

Maroulis

Karavias

2011

Tech Coloproctol

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“…das postoperative Überleben zu verbessern (z.B. adjuvante Chemotherapie beim Pankreaskarzinom [6,10] [20]. Interessanterweise kam es trotz mehrfacher Veröffentlichung der Daten zu keiner deutlichen Verände-rung des Einweisungsverhaltens und damit des Anteils an Patienten, die an Low-volume-Zentren operiert wurden [20].…”

Section: Hepato-pankreatiko-biliäre Chirurgie Im Fokus Der Zentrumsbiunclassified

Sind Zentren für hepato-pankreatiko-biliäre Erkrankungen sinnvoll?

Seehofer¹

2011

Viszeralmedizin

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Die hepato-pankreatiko-biliäre (HPB) Chirurgie hat sich in den letzten 30 Jahren rasant weiterentwickelt. Während sie anfangs in wenigen spezialisierten Zentren angeboten wurde, hat sie heute zunehmend Einzug in die breite Versorgungschirurgie gefunden. Allerdings gibt es Hinweise aus epidemiologischen Untersuchungen, dass insbesondere in der Pankreaschirurgie, aber auch in der komplexen Leberchirurgie die postoperative Ergebnisqualität mit den Fallzahlen eines Krankenhauses bzw. Chirurgen korreliert. Aufgrund der verfügbaren Daten wurden in Deutschland auch Mindestmengen in der Pankreaschirurgie eingeführt. In der Leberchirurgie existieren bisher keine Mindestmengenvorgaben, unter anderem aufgrund des wesentlich breiteren Spektrums – angefangen von relativ einfachen bis hin zu höchst komplexen Eingriffen. Aktuell existieren zwei Zertifizierungsmöglichkeiten für Leber- oder Pankreaszentren. Dabei liegt der Schwerpunkt der Zertifikate der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) auf der chirurgischen Therapie, während die Zertifikate der Deutschen Krebsgesellschaft (DKG) eher interdisziplinär onkologisch ausgerichtet sind. Aus unserer Sicht erscheint sowohl medizinisch als auch ökonomisch eine Zentrumsbildung bei relativ seltenen Erkrankungen und bei überdurchschnittlich riskanten und komplexen Eingriffen – wie in der HPB-Chirurgie – über kurz oder lang sinnvoll und unumgänglich. Die Frage nach der optimalen bzw. akzeptablen Größe und der genauen Strukturierung der jeweiligen Zentren ist bisher allerdings noch unzureichend beantwortet.

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mentioning

confidence: 99%

“…3,4 Several clinical studies have shown that the association of chemotherapy with bevacizumab (vascular endothelial growth factor monoclonal antibody), or cetuximab [epidermal growth factor receptor (EGFR) monoclonal antibody] is particularly promising in improving the resectability rate and, ultimately, survival. 5 Panitumumab is a fully human monoclonal antibody that binds specifically to the EGFR, and consequently, severe panitumumab-related infusion reactions are rare.…”

mentioning

confidence: 99%

Conversion Therapy Using mFOLFOX6 With Panitumumab for Unresectable Liver Metastases From Multiple Colorectal Cancers With Familial Adenomatous Polyposis

Toiyama

Inoue

Kitajima

et al. 2014

International Surgery

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A 39-year-old man received a diagnosis of unresectable multiple liver metastases from multiple colorectal cancers with familial adenomatous polyposis. After construction of an ileostomy, modified FOLFOX6 (mFOLFOX6) with panitumumab was administrated because rectal cancer and sigmoid colon cancer are KRAS wild type. The 13 courses of chemotherapy resulted in a marked reduction in the size of liver metastases and sigmoid colon cancer. Consequently, curative resection with total colectomy, ileal pouch anal anastomosis, and liver metastasis resection with radiofrequency ablation was performed. Progression of KRAS wild-type rectal cancer after chemotherapy suggested that each clone from rectal and sigmoid colon cancer might have a different sensitivity to epidermal growth factor receptor antibody. Immunohistochemical analysis revealed loss of PTEN expression in rectal cancer compared with liver metastases from sigmoid colon cancer, showing that the difference of mFOLFOX6 with panitumumab might be related to activation of the PI3K-AKT pathway.Key words: Panitumumab -mFOLFOX6 -Colorectal cancer -Liver metastases -Familial adenomatous polyposis T he only available treatment associated with long-term survival in patients with liver metastases from colorectal cancer is complete liver tumor resection, with 5-year survival rates ranging from 25% to 57%.1 However, only 40% to 50% of patients with colorectal metastasis to the liver are eligible for surgical resection.2 Therefore, other liver metastasis patients undergo palliative chemotherapy to stabilize the disease and prolong their overall survival.During the past decade, the biggest advance made regarding unresectable liver metastases from colorectal cancer has been the ability of oncologists to convert inoperable liver disease to resectable disease using various molecular targeting drugs. 3,4 Several clinical studies have shown that the association of chemotherapy with bevacizumab (vascular endothelial growth factor monoclonal antibody), or cetuximab [epidermal growth factor receptor (EGFR) monoclonal antibody] is particularly promising in improving the resectability rate and, ultimately, survival. 5Panitumumab is a fully human monoclonal antibody that binds specifically to the EGFR, and consequently, severe panitumumab-related infusion reactions are rare. Panitumumab, when added to FOLFOX4 (folinic acid, 5-fluorouracil, and oxaliplatin), increased response rate and improved progression-free survival in previously untreated metastatic colorectal cancer. 6 Retrospective analyses of phase 3 trials of anti-EGFR antibodies, including cetuximab and panitumumab, found KRAS status to be an important predictive marker of efficacy, with only wild-type patients benefiting from treatment. Here, we report a successful conversion therapy using modified FOLFOX6 (mFOLFOX6) plus panitumumab in a patient with familial adenomatous polyposis (FAP) who had unresectable multiple liver metastases from multiple colorectal cancers. To the best of our knowledge, we are the first researchers to d...

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Evolution of neoadjuvant therapy for extended hepatic metastases—have we reached our (non‐resectable) limit?

Cited by 34 publications

References 94 publications

General principles of hepatectomy in colorectal liver metastases

General principles of hepatectomy in colorectal liver metastases

Sind Zentren für hepato-pankreatiko-biliäre Erkrankungen sinnvoll?

Conversion Therapy Using mFOLFOX6 With Panitumumab for Unresectable Liver Metastases From Multiple Colorectal Cancers With Familial Adenomatous Polyposis

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