Review
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 21, 2009; 15(31): 3855-3864
Published online Aug 21, 2009. doi: 10.3748/wjg.15.3855
Secondary hepatic resection as a therapeutic goal in advanced colorectal cancer
Muhammad Wasif Saif
Muhammad Wasif Saif, Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06519, United States
Author contributions: Saif MW wrote this review.
Correspondence to: Muhammad Wasif Saif, MD, Associate Professor, Yale Medical Oncology, 800 Howard Avenue, Yale Physicians Building, 2nd Floor, New Haven, CT 06519, United States. wasif.saif@yale.edu
Telephone: +1-203-7371569
Fax: +1-203-7372617
Received: April 23, 2009
Revised: July 2, 2009
Accepted: July 9, 2009
Published online: August 21, 2009
Abstract

Surgery is the only curative option for patients with liver metastases of colorectal cancer, but few patients present with resectable hepatic lesions. Chemotherapy is increasingly used to downstage initially unresectable disease and allow for potentially curative surgery. Standard chemotherapy regimens convert 10%-20% of cases to resectable disease in unselected populations and 30%-40% of those with disease confined to the liver. One strategy to further increase the number of candidates eligible for surgery is the addition of active targeted agents such as cetuximab and bevacizumab to standard chemotherapy. Data from a phase III trial indicate that cetuximab increases the number of patients eligible for secondary hepatic resection, as well as the rate of complete resection when combined with first-line treatment with the FOLFIRI regimen. The safety profiles of preoperative cetuximab or bevacizumab have not been thoroughly assessed, but preliminary evidence indicates that these agents do not increase surgical mortality or exacerbate chemotherapy-related hepatotoxicity, such as steatosis (5-fluorouracil), steatohepatitis (irinotecan), and sinusoidal obstruction (oxaliplatin). Secondary resection is a valid treatment goal for certain patients with initially unresectable liver metastases and an important end point for future clinical trials.

Keywords: Colorectal cancer; Liver metastases; Liver resection; Cetuximab; Bevacizumab; Hepatotoxicity