Analysis supports neoadjuvant chemotherapy in CLM

Patients with resectable colorectal liver metastases are likely to benefit from neoadjuvant chemotherapy, a systematic review by Australian doctors finds. Dr Terence Chua and colleagues from St George’s Hospital in New South Wales reviewed evidence from 23 studies and nearly 3,300 patients on the effect of preoperative systemic chemotherapy on both clinical response to treatment and survival outcomes. Writing in the Annals of Surgical Oncology, the doctors said that despite rationalised benefits of neoadjuvant chemotherapy prior to hepatectomy, there is still no universal agreement among treating surgeons and medical oncologists, due in part to the question of its oncologic benefits and of chemotherapy–induced hepatic parencymal injury that may increase morbidity and mortality after surgery. The review found that objective radiological response was observed in 64% of patients, with 4% experiencing complete response after neoadjuvant chemotherapy. Pathologically, a median of 9% and 36% had complete and partial response, respectively, and median disease-free survival was 21 months while median overall survival was 46 months. The review also found median perioperative mortality and morbidity rates of 2% and 27%, respectively. “Current evidence suggests that objective response to neoadjuvant chemotherapy may be achieved with improvement in disease free survival in patients with resectable CLM,” the authors concluded. However, they noted that a randomised controlled trial that compares neoadjuvant therapy to adjuvant therapy after liver resection is required to determine the optimal perisurgical treatment regimen. Annals of Surgical Oncology; online first.  ...