Induction Chemotherapy Followed by Primary Tumor Resection Did Not Bring Survival Benefits in Colon Cancer Patients With Asymptomatic Primary Lesion and Synchronous Unresectable Metastases

Abstract

BackgroundIt is still controversial whether primary tumor resection (PTR) improves survival in colorectal cancer (CRC) patients with unresectable metastases.MethodsColon cancer patients were enrolled and randomly allocated to with or without PTR after induction chemotherapy with XELOX or mFOLFOX6, and those with chemotherapy failure were excluded. The primary endpoint was TTF (time to strategy failure) on an intent-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT02291744.ResultsBetween April 2015 and July 2020, 140 patients were enrolled, and 54 patients were excluded due to colon obstruction (16), perforation (1), disease progression (22), death (1), radical resection (3), or other reasons (11). After induction chemotherapy, 86 patients were randomized into group A (the resection group, n = 42) or group B (chemotherapy-alone group, n = 44). The median TTF was 143 days (95% CI: 104.9–181.1) in group A and 196 days (95% CI: 96.5–295.5) in group B (HR: 0.930 95% CI: 0.589–1.468, p = 0.755), and there was no significant difference in PFS, OS, and incidence of chemotherapy-related adverse events between two groups. The primary lesion-related events after PTR in group A were significantly fewer than those in group B. Patients with a tumor regression grade (TRG) score of 2 had longer TTF and PFS than those with score of 3.ConclusionPTR after induction chemotherapy could not bring survival benefits for colon cancer patients with unresectable metastases, and it is not recommended routinely. However, it also requires individualized treatment as colon obstruction or perforation occurred in some patients and PTR could reduce primary tumor-related events, and the TRG score might help for selection of beneficial patients.

The ubiquitin-like protein UBTD1 promotes colorectal cancer progression by stabilizing c-Myc to upregulate glycolysis

“…Colorectal cancer (CRC) is one of the most common malignancies worldwide, with over 1.88 million patients diagnosed with CRC and more than 0.91 million dying from it in 2020, making it a major threat to human health globally [ 1 ]. However, for advanced or metastatic CRC, the efficacy of traditional treatments, including chemotherapy, radiotherapy, palliative surgery, and target therapies had reached a plateau recently [ 2 , 3 ]. Though the immune checkpoint inhibitors therapy shows significant anti-tumor activities and become the backbone of the regimes for several cancer types, including microsatellite instability-high CRC, this therapy exhibits marginal benefits for microsatellite stable CRC, which constitutes the majority of this malignancy [ 4 ].…”

PROX1-mediated epigenetic silencing of SIRT3 contributes to proliferation and glucose metabolism in colorectal cancer

“…The most common treatment for metastatic colorectal cancer (mCRC) is systemic chemotherapy and molecular targeted drugs. Nevertheless, for patients with asymptomatic primary lesion and synchronous unresectable metastases, induction chemotherapy followed by primary tumor resection can't bring Ivyspring International Publisher survival benefits [4]; and currently applied standard second-line chemotherapy regimen, such as FOLFIRI (folinic acid, fluorouracil, and irinotecan), has been proved increases not efficacy but toxicity in patients with mCRC [5]. In recent years, there has been considerable progress in the research and development of checkpoint inhibitors for mCRC with microsatellite-high (MSI-H) status and drugs targeting BRAF-mutant CRC.…”