Survival of patients with liver metastases from colorectal cancer treated with bevacizumab and FOLFOX4.

Purpose: In patients with colorectal liver metastases (CLM) a long term survival and a probability of cure might be achieved with the surgical treatment of metastatic sites after prior application of systemic treatment. The purpose of this study was to assess the survival of patients with unresectable CLM treated with bevacizumab (bev) and FOLFOX4 (FOLFOX-bev) and to compare survival according to patient, disease and treatment characteristics. Methods: This research included 110 patients with unresectable CLM treated with FOLFOX-bev. Treatment response and resectability were estimated every 3 months. If resectability was achieved, patients were operated on and followed. Patient, disease and treatment characteristics in patients with and without hepatectomy were compared. Survival was estimated according to Kaplan-Meier method. Comparison of survival according to patient, disease and treatment characteristics was performed using log-rank test. Results: In patients with hepatectomy, treatment response was significantly more frequent (63, 63% vs 16, 66%, p<0.001). One- and three-year survival rate for the whole group was 87, 3% and 36, 1%, respectively; median overall survival (OS) was 23 months (95%CI 19, 63-28, 26). One- and three-year survival for patients with hepatectomy was 98, 48%, and 54, 76%, respectively; median OS was 35 months (95%CI 28, 83-41, 17). Three-year survival was significantly better in patients with hepatectomy (HR=3.775; 95%CI 2.150-6.627, p<0.001), older than 60 years (p=0.033), those without extrahepatic metastases (p=0.008) and those with treatment response (p=0.05). Conclusion: Significantly better survival had patients with hepatectomy, treatment response, older than 60 years and without extrahepatic metastases. FOLFOX4-bev is effective treatment for molecularly unselected patients.

Current and future targets and therapies in metastatic colorectal cancer.

Colorectal cancer (CRC) is the third most common cancer and the second cause of cancer-related deaths worldwide. Despite early diagnosis and treatment improvement, the majority of patients will still suffer from metastatic disease (mCRC), which has a poor prognosis. Molecular diversity of CRC requires personalized targeted approach for improving patient outcomes. Antiangiogenic agents proved to be beneficial in the continuum of mCRC treatment. For efficient epidermal growth factor receptor (EGFR) directed therapy, subtle molecular selection and better strategies to overcome resistance are needed. BRAF mutant and HER-2 positive mCRC will soon be provided with approved targeted treatments and check-point inhibitors demonstrated effectiveness in microsatellite instability (MSI) - high mCRC. Moreover, numeorous promising agents are entering clinical trial arena. This review summarizes actual and possible targets and current and promising agents for mCRC treatment. With broader accessibility of liquid biopsy we could track molecular evolution of CRC and target genetic alterations as they emerge.