Primary Tumour Resection Could Improve the Survival of Unresectable Metastatic Colorectal Cancer Patients Receiving Bevacizumab-Containing Chemotherapy

Abstract

Background: The effect of primary tumour resection (PTR) among metastatic colorectal cancer (mCRC) patients remains controversial. Combination chemotherapy with bevacizumab could improve the clinical outcomes of these patients, which might change the importance of PTR in the multi-disciplinary treatment pattern. Methods: We performed a non-randomized prospective controlled study of mCRC pts whose performance status (PS) scored ≤2 and who received bevacizumab combination chemotherapy (FOLFOX/XELOX/FOLFIRI) as a first-line therapy. These patients were classified into the PTR group and the IPT (intact primary tumour) group according to whether they underwent PTR before receiving the systemic therapy. The progression free survival (PFS) time and overall survival (OS) time, which were recorded from the start of the primary diagnosis until disease progression and death or last follow-up, were analysed. We also compared severe clinical events (such as emergency surgery, radiation therapy, and stent plantation) between the two groups. Results: One hundred and nighty-one mCRC pts (108 male patients and 93 female patients) were entered in this prospective observational study. The median age was 57.5 years old. The clinical characteristics (age, gender, performance status, primary tumour site, RAS status, and the number of metastatic organs) did not significantly differ between the two groups. The median PFS and OS times of the PTR group were superior than those of the IPT group (10.0 vs 7.8 months, p < 0.01 and 22.5 vs 17.8 months, p < 0.01, respectively). The incidences of adverse events associated with systemic therapy were similar between the two groups. Specifically, sixteen patients (21.9%, 16/73) with IPT developed significant primary tumour-related complications, such as bleeding, obstruction or even perforation. Among these patients, five underwent emergency surgery, three patients received a stent, and eight patients underwent radiation therapy. Conclusions: The mCRC patients who received PTR and bevacizumab combination chemotherapy had better clinical outcomes than patients who did not receive PTR. PTR also decreased the incidence of severe clinical events and improved quality of life.

Meta-analysis of oncologic effect of primary tumor resection in patients with unresectable stage IV colorectal cancer in the era of modern systemic chemotherapy

“…All 17 studies evaluated OS [ 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ], whereas only two evaluated PFS [ 24 35 ]. Three studies examined patients with colon cancer exclusively [ 28 32 38 ], one examined patients with rectal cancer exclusively [ 25 ], and 13 examined patients with colorectal cancer [ 23 24 26 27 29 30 31 33 34 35 36 37 39 ]; in 3 of the latter studies, data on patients with colon cancer could be separated from data on patients with rectal cancer [ 34 37 39 ]. Thirteen studies evaluated patients who received targeted chemotherapy [ 23 24 26 27 28 29 30 31 32 33 34 35 39 ].…”

An Analysis of Relationship Between RAS Mutations and Prognosis of Primary Tumour Resection for Metastatic Colorectal Cancer Patients

“…However, Chinese colorectal cancer patients who are initially diagnosed as metastatic diseases are more willing to have a non-radical resection rather than receive palliative systemic chemotherapy until disease progression, which gave us a favorable opportunity to launch this retrospective observational cohort study [35]. In our center, the decision of receiving PTR treatment was made according to patients' intention, surgeons' assessment of surgery treatment risk as well as some other patients' condition and clinical features, such as abdominal pain, bloating and other mild symptoms which suggested probable aggravation.…”

Cetuximab Enhanced the Cytotoxic Activity of Immune Cells during Treatment of Colorectal Cancer

“…The impact of CRC has been a global health issue over the past decade [29, 30]. Studies have suggested that a high prevalence of mortality, recurrence and metastasis of CRC is associated with immunocompromised patients.…”