This Article Full Text Full Text (PDF) All Versions of this Article: theoncologist.2008-0142v1 13/10/1063    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alberts, S. R. Articles by Wagman, L. D. Search for Related Content PubMed PubMed Citation Articles by Alberts, S. R. Articles by Wagman, L. D.

Gastrointestinal Cancer

Chemotherapy for Colorectal Cancer Liver Metastases

^aMayo Clinic, Rochester, Minnesota, USA; ^bSt. Joseph Hospital, Center for Cancer Prevention and Treatment, Orange, California, USA

Key Words. Chemotherapy • Colorectal cancer • Liver metastases • Oxaliplatin • 5-fluorouracil

Correspondence: Steven R. Alberts, M.D., M.P.H., Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55901, USA. Telephone: 507-284-8965; Fax: 507-284-1803; e-mail: alberts.steven{at}mayo.edu

Received June 27, 2008; accepted for publication August 17, 2008; first published online in THE ONCOLOGIST Express on October 6, 2008.

Disclosure: Employment/leadership position: None; Intellectual property rights/inventor/patent holder: None; Consultant/advisory role: Lawrence D. Wagman, Medwaves, Inc., San Diego, CA; Honoraria: Lawrence D. Wagman, Angiodynamics; Research funding: Steven R. Alberts, Bristol-Myers Squibb, Pfizer, Sanofi-Aventis; Ownership interest: None; Expert testimony: None; Other: None. The article discusses the neoadjuvant use of drugs manufactured or provided by Roche, Merck, and Sanofi-Aventis. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

Colorectal cancer (CRC) is a highly prevalent malignant disease in industrialized nations. The annual incidence of invasive CRC in the U.S. is among the highest in the world, and the liver is the only metastatic site in approximately one third of patients. Without treatment, patients with metastatic disease have a poor prognosis; however, long-term survival benefits and even cure have been reported in patients undergoing surgical resection of metastases. In addition, advances in chemotherapy, imaging, and surgical techniques have increased the proportion of patients who are eligible for resection. Combination therapy with fluorouracil and leucovorin has been the mainstay of treatment for metastatic CRC; however, the introduction of newer agents, such as oxaliplatin and irinotecan, and targeted agents, such as cetuximab and bevacizumab, has yielded improvements in response rates (RRs) and survival. Maximizing the exposure of hepatic metastases to high target concentrations of cytotoxic drugs using hepatic arterial infusion (HAI) increases RRs further than with systemic chemotherapy; however, the impact of HAI on survival is unclear. As the goals of chemotherapeutic treatment for metastatic CRC increasingly shift from palliation to prolongation of survival, improvement in RRs, and downsizing of tumors in order to enable or optimize resection, treatment in a multidisciplinary environment involving a medical oncologist, radiologist, and surgical oncologist with hepatobiliary expertise will become central to deciding the best course of therapy and timing of surgery.

This article has been cited by other articles:

				K. Dezso, E. Bugyik, V. Papp, V. Laszlo, B. Dome, J. Tovari, J. Timar, P. Nagy, and S. Paku Development of Arterial Blood Supply in Experimental Liver Metastases Am. J. Pathol., August 1, 2009; 175(2): 835 - 843. [Abstract] [Full Text] [PDF]