Surgical treatment options following chemotherapy plus cetuximab or bevacizumab in metastatic colorectal cancer—central evaluation of FIRE-3

Modest, Dominik Paul; Denecke, Timm; Pratschke, Johann; Ricard, Ingrid; Lang, Hauke; Bemelmans, M. H. A.; Becker, Thomas; Rentsch, Markus; Seehofer, Daniel; Bruns, Christiane; Gebauer, Bernhard; Modest, Heike; Held, Swantje; Folprecht, Gunnar; Heinemann, Volker; Neumann, Ulf

doi:10.1016/j.ejca.2017.10.028

Cited by 81 publications

(70 citation statements)

References 22 publications

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“…Previous work showed that MDTs changed the proposed treatment strategy in up to 25 per cent of patients with pancreatic cancer. Other studies have reported considerable variation in judgement of resectability in, for example, liver resection for colorectal liver metastases. Yet, a comparison of outcomes across different MDTs has not yet been undertaken.…”

Section: Introductionmentioning

confidence: 99%

Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation

Kirkegård

Aahlin

Al-Saiddi

et al. 2019

British Journal of Surgery

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Background: Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed.Methods: Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical information and radiological images were disseminated to the MDTs. All patients were reviewed by the MDTs for radiological T, N and M category, resectability assessment and treatment allocation. Each MDT was blinded to the decisions of other teams. Agreements were expressed as raw percentages and Krippendorff's values, both with 95 per cent confidence intervals.Results: A total of 132 evaluations in 19 patients were carried out by the seven MDTs (1 evaluation was excluded owing to technical problems). The level of agreement for T, N and M categories ranged from moderate to near perfect (46⋅8, 61⋅1 and 82⋅8 per cent respectively), but there was substantial variation in assessment of resectability; seven patients were considered to be resectable by one MDT but unresectable by another. The MDTs all agreed on either a curative or palliative strategy in less than half of the patients (9 of 19). Only fair agreement in treatment allocation was observed (Krippendorff's 0⋅31, 95 per cent c.i. 0⋅16 to 0⋅45). There was a high level of agreement in treatment allocation where resectability assessments were concordant.Conclusion: Considerable disparities in MDT evaluations of patients with pancreatic cancer exist, including substantial variation in resectability assessments.

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Section: Introductionmentioning

confidence: 99%

Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation

Kirkegård

Aahlin

Al-Saiddi

et al. 2019

British Journal of Surgery

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“…[1][2][3] The criteria to select patients for resection are not yet standardized and may differ from one unit to another, as well as between surgeons and medical oncologists. [4][5][6] Accordingly, the current ESMO guideline recommends secondary interventions in patients with oligo-metastatic diseasedefined rather vaguely as limited (in terms of lesions and involved organs) disease spread. 2 Consequently, the concept of oligometastatic disease allows for local therapy in patients with mCRC with the disease not necessarily limited to one organ or an exact number of lesions.…”

mentioning

confidence: 99%

“…This exploratory analysis suggested that locoregional interventional treatment might have been possible in markedly more patients than was actually performed. 13 Furthermore, the central review provided scores of the presented images for technical difficulty and prognostic impact of a potential intervention.…”

mentioning

confidence: 99%

Factors That Influence Conversion to Resectability and Survival After Resection of Metastases in RAS WT Metastatic Colorectal Cancer (mCRC): Analysis of FIRE-3- AIOKRK0306

et al. 2020

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Background. Tumor assessments after first-line therapy of RAS wild-type mCRC with cetuximab (cet) versus bevacizumab (bev) in combination with FOLFIRI were evaluated for factors influencing resectability, conversion to resectability, and survival after best response. Methods. Conversion to resectability was defined as conversion of initially unresectable to resectable disease at best response as determined by retrospective assessment. Univariate and multivariate logistic models were fitted with resectability at best response as response variable. A Cox model comparing the survival from best response was used to measure the influence of treatment, resectability at best response, and resection. Interaction of resection and treatment arm on survival was tested by likelihood ratio test. Results. Overall, 270 patients were evaluable (127 cetarm, 143 bev-arm). Lung metastases (odds ratio [OR] 0.35, 95% confidence response [CI] 0.19-0.63), BRAF mutation (OR 0.33, 95% CI 0.12-0.82), and elevated alkaline phosphatase (OR 0.42, 95% CI 0.18-0.9) before randomization were associated with less chance of successful conversion and were integrated into a nomogram. Early tumor shrinkage (OR 1.86, 95% CI 1.06-3.3; p 0.034) and depth of response (OR 1.02, 95% CI 1.01-1.03; p \ 0.001) were associated with successful conversion therapy. Resection of metastases improved post-best-response survival (hazard ratio 0.53, 95% CI 0.29-0.97; p = 0.039),

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“…However, most modern series report metastasectomy rates from 30% to 40% in the setting of doublet or triplet therapy when assessed by blinded reviewers and report 10% to 20% R0 resection rates. [38][39][40] Adding cetuximab or bevacizumab to a doublet chemotherapy did not meaningfully improve conversion or R0 resection rates. 27,41,42 Triplet chemotherapy combined with bevacizumab has been associated with resection rates as high as 67%.…”

Section: Chemotherapymentioning

confidence: 92%

“…The degree to which modern chemotherapy regimens render resectability is difficult to ascertain due to differences in defining “unresectable” liver metastases across studies. However, most modern series report metastasectomy rates from 30% to 40% in the setting of doublet or triplet therapy when assessed by blinded reviewers and report 10% to 20% R0 resection rates . Adding cetuximab or bevacizumab to a doublet chemotherapy did not meaningfully improve conversion or R0 resection rates .…”

Section: Chemotherapymentioning

confidence: 96%

Treatment sequencing for simultaneous colorectal liver metastases

Krell

2019

Journal of Surgical Oncology

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Up to 25% of patients with colorectal cancer present with simultaneous metastases and the liver is frequently the only metastatic site. This review will review treatment sequence planning considerations—including metastatic burden, primary tumor site, chemotherapy response, and ability to perform minimally invasive surgery—for patients with simultaneous resectable colorectal liver metastases. In addition, this review will address conversion chemotherapy, combined vs staged surgeries, and their possible sequences.

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Surgical treatment options following chemotherapy plus cetuximab or bevacizumab in metastatic colorectal cancer—central evaluation of FIRE-3

Cited by 81 publications

References 22 publications

Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation

Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation

Factors That Influence Conversion to Resectability and Survival After Resection of Metastases in RAS WT Metastatic Colorectal Cancer (mCRC): Analysis of FIRE-3- AIOKRK0306

Treatment sequencing for simultaneous colorectal liver metastases

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