More Months of Life with Colorectal Cancer

Cetuximab and chemo make surgery possible for colorectal cancer liver mets

(RxWiki News) Once cancer has spread to another organ, treatment options become more limited. In a good news story, researchers may have found a way to help folks whose advanced colorectal cancer has spread to the liver.

Adding Erbitux (cetuximab) to chemotherapy shrinks liver tumors in advanced colorectal cancer patients to the point that the tumors can be surgically removed.

This process was shown to extend the lives of patients previously thought to have inoperable tumors.

"Ask your oncologist about combination therapies."

Cetuximab plus chemotherapy is a standard of care for advanced colorectal cancer. Jianmin Xu, MD, PhD, a surgeon at the Zhongshan Hospital, Fudan University, in Shanghai, China, led this phase III clinical trial to see how this combination treatment specifically impacted inoperable liver metastases (tumors that have spread).

The liver is often the first place that colorectal cancer spreads. For about 35 percent of patients, the liver is the only place where the cancer metastasizes.

Neal Meropol, MD, American Society of Clinical Oncology (ASCO) Cancer Communications Committee member and gastrointestinal cancers expert, told dailyRx news, “Many people don’t realize that even after colon cancer has spread to the liver, it may still be curable. But cure requires that a surgeon can remove the liver tumors. This study involved patients whose liver tumors were initially too extensive to be removed by a surgeon.“

For this study, researchers worked with 138 patients who had liver metastasis at the time of their colorectal cancer diagnosis, something that happens in about 20 percent of patients.

Patients with stage IV colorectal cancer were randomly assigned to either cetuximab (Group A) or chemotherapy alone (Group B).

“The standard treatment in this setting is chemotherapy, with the hope that the tumor will shrink to the point that it could be removed surgically. The researchers asked the question of whether giving an antibody, cetuximab, that targets colon cancers, in addition to chemotherapy, can increase the chances that the tumor will shrink enough to be removed," said Dr. Meropol, who is chief of the Division of Hematology and Oncology Case Medical Center and Case Western Reserve University School of Medicine.

Study members received standard chemotherapy regimens were either FOLFIRI (leucovorin, fluorouracil and irinotecan) or the mFOLFOX6 (leucovorin, fluorouracil, and oxaliplatin) chemotherapy drug combination.

The study revealed:

  • 26 percent who received the cetuximab became eligible for surgery versus 7 percent of the patients who didn’t receive the combination therapy.
  • Those in the cetuximab group who had surgery lived significantly longer – an average of 46.4 months – compared to an average 25.7 months for the group who didn’t have surgery.
  • The combination therapy resulted in greater tumor shrinkage (57 percent versus 29 percent).
  • Overall survival for patients who received cetuximab was 30.5 months compared to 21 months who didn’t receive the combination therapy.

“This study adds to a growing body of evidence that some patients with inoperable metastases to liver can be rendered surgical candidates with chemotherapy. These compelling data show that combining cetuximab with chemotherapy can make liver metastasis operable, more so than chemotherapy alone, offering many such patients a chance for longer survival and potential for cure,” Dr. Meropol said.

This study was published April 8 in the Journal of Clinical Oncology, an ASCO peer-reviewed journal. The research was supported by Key Projects of the Clinical Disciplines, administered by the Ministry of Health. No conflicts of interest were disclosed.

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Review Date: 
April 8, 2013