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Long time outcome of conversion therapy to resection with mFOLFOX6 with Bevacizumab or Cetuximab based on K-ras status for unresectable colorectal liver metastasis
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Etsuro Hatano1,
Rei Toda2,
Shinji Uemoto2 |
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1Department of Surgery, Hyogo College of Medicine, 2Department of Surgery, Graduate School of Medicine, Kyoto University |
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| Background Recent findings that patients with initially unresectable colorectal liver metastasis (CRLM) can become resectable after responding to chemotherapy have led to the introduction of the concept of ‘ conversion therapy’ into clinical practice. We conducted a multiinstitutional phase II trial for unresectable CRLM. Combined chemotherapy based on Kras status can facilitate conversion to resection in patients with unresectable CRLM (J Hepatobiliary Pancreat Sci, 2015). However, the long term survival outcome for this conversion strategy was not clarified. Methods Patients received mFOLFOX6 with either bevacizumab (bev) or cetuximab (cet) based on Kras status. Patients whose disease was unresectable after 6 cycles switched their chemotherapy regimen from mFOLFOX6 to FOLFIRI. Results A total of 22/12 patients with Kas wild/mutant (wt/mt) were treated with mFOLFOX6 plus cet/bev, respectively. The overall response rate was 64.7%. Finally, 23 patients (67.6%) underwent hepatectomy, including two patients receiving two-staged hepatectomy and one receiving ALPPS. The overall R0 resection rate was 47.1%. Two patients suffered from grade IIIa complications. No surgical mortality was observed. The 5-year disease-free and overall survival (OS) was 19.4% and 58.9%. The 5-year OS in patients with/without hepatectomy was 72.8% vs. 26.7%, respectively (p＜0.01). Conclusion Chemotherapy and targeted therapy based on K-ras status can facilitate conversion to resection (67.6%) in patients with unresectable CRLM, resulting in the long-time survival outcome of the patients with hepatectomy (5y-OS; 72.8%). |
Index Term 1: conversion
Index Term 2: Ras |
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