In a retrospective

In a retrospective Idelalisib CLL review, systemic chemotherapy demonstrated the ability to convert 13% of patients with initially unresectable CRLM to resectable status with a postoperative 5-year survival rate of 33%.9 Other reports have also demonstrated the use of chemotherapy regimens to downstage the size of tumours in order to convert unresectable tumours to resectable status. The recently published Eloxatin? for peri-operative use (EPOC) trial (European Organization for Research and Treatment of Cancer [EORTC] 40893), conducted by Nordlinger’s group, is the first randomized trial of perioperative chemotherapy to demonstrate a progression-free survival advantage for patients using this strategy.10 However, other publications highlight the liver toxicities and potential perioperative morbidity and mortality associated with preoperative chemotherapy.

11,12 Another potential advantage of perioperative chemotherapy was recently proposed by Blazer et al. from MD Anderson Cancer Center.13 In their paper, the authors highlight the importance of response to preoperative chemotherapy as a predictor of postoperative outcome. It would therefore seem logical to choose the chemotherapy with the highest response rate in the preoperative setting. The perioperative use of bevacizumab ([Bev] Avastin?; Hoffmann-Laroche, Basel, Switzerland), a humanized monoclonal antibody that targets vascular endothelial growth factor (VEGF), remains controversial. Although the survival benefit of Bev used in the palliative setting has been established,14 its impact on response rate is not as clear as recent data from the NO16966 trial failed to show an increased response rate when Bev was combined with FOLFOX-4.

15 Despite this, Bev is commonly used in combination with cytotoxic chemotherapy before surgical resection in patients with CRLM. Because of reports of haematologic Anacetrapib toxicity, intestinal perforation and an increased risk of postoperative bleeding, surgeons and oncologists have been reluctant to use Bev in the perioperative setting. However, a retrospective study from the MD Anderson showed no significant increase in hepatobiliary or wound complications, and no postoperative deaths in patients who received preoperative Bev.16 In the same series, only 12% of patients experienced preoperative adverse events related to Bev therapy. Other series have also confirmed that the neoadjuvant use of Bev in combination with cytotoxic agents did not significantly increase postoperative complications.17�C19 In the current study, we review our experience with a Bev and oxaliplatin-based chemotherapy regimen administered to patients with CRLM perioperatively in order to determine the safety and efficacy of this regimen and its impact on survival.

Leave a Reply

Your email address will not be published. Required fields are marked *

*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>