Chemotherapy with Surgery Can Reduce Return of Cancer to the Liver for Patients with Colorectal Cancer

June 4, 2007

Giving chemotherapy before and after surgery to remove cancer that has spread to the liver in patients with colorectal cancer significantly lowers the risk of the cancer returning to the liver. It is the first study to date to evaluate this treatment, and was led by the European Organization for Research and Treatment of Cancer (EORTC), with the participation of four major European cancer organizations.

Colorectal cancer spreads to the liver in up to 50% of patients. Although liver tumors are removed whenever possible, the cancer often comes back. Approximately 30% to 35% of patients with cancer that has spread to the liver survive five years after removal of the liver tumors.

In this phase III clinical trial, 364 patients with colorectal cancer that spread to the liver and who were able to have surgery were assigned one of two treatments. Half the patients received six cycles of FOLFOX4 chemotherapy to shrink the tumors before surgery and six cycles after surgery, and the other half received only surgery. FOLFOX4 chemotherapy consists of fluorouracil (5-FU, Adrucil), leucovorin (Wellcovorin), and oxaliplatin (Eloxatin).

For various medical reasons, not all of the patients were able to have surgery. Overall, 151 patients who received chemotherapy and 152 patients who had surgery had liver tumors removed. After about four years, the cancer did not come back in the liver in 42% of the patients who received chemotherapy, compared with 33% of the patients who did not receive chemotherapy

What This Means for Patients

"This approach may become the standard of care for patients with colorectal cancer whose cancer has spread to the liver and can be surgically removed," said Bernard Nordlinger, MD, Professor of Surgery and Chairman of Surgery and Oncology at Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris. "The findings also support a multidisciplinary approach to care, with all members of the patient's health-care team collaborating to find the best combination of chemotherapy and surgery."