Systematic Therapy Approach Following Metastatic Resection Featuring Dr Vijayvergia

Nareem Vijayvergia, MD, Fox Chase Cancer Center, discusses standard observation in systematic therapy following metastatic resection, a debate presented at the 2022 GDU GI Annual Meeting.

Transcript

Hello everyone. My name is Namrata Vijayvergia. I am a GI medical oncologist at Fox Chase Cancer Center, and I am very excited to be at the Great Debates & Updates this year in 2022 live in New York. So I was entasked with two debates and one was to assess the role of HIPEC with CRS in colorectal cancer and I was supposed to talk about that there's no role of HIPEC. And the second one was to look at if there's a role for any systemic therapy after colorectal liver metastasis resection.

The reason I actually got very excited about these two topics was, they were trying to steer away from the idea of more is better. We always think more is better, and we always are enticed to do that, but we always have to take a step back and make sure that more is always better and the two studies that I point out and these topics talk about it. So let's talk about the first one.

So in colorectal cancer, liver metastases, it's a very bad problem. About 50% to 70% of patients who have recurrent disease have liver metastases and even with resection about, 50% to 75% of them ultimately recur. So it presents its opportunity, maybe we can do something more to decrease the chances of recurrence in these patients. We started using chemotherapy, extrapolated data from FOLFOX or other combination therapies to improve outcomes. Time after time, multiple studies have shown, be it the EORTC40983 or the EPOCH trial, or the more recent one, the JCOG0603 study. Both of which found that perioperative therapy or adjuvant therapy with FOLFOX did not improve overall survival (OS). In both these studies, the disease re-survival was slightly better, but it didn't translate into an OS benefit.

And that's important to know because you're giving toxicities of chemotherapy and if there's OS benefit, is that really the right thing to do? So I definitely ward for standard observation and not put patients through chemotherapy side effects, and if and when they recur to it or develop modern approaches and someone else is going to talk about that.