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Target Oncol. 2016 Feb;11(1):83-92. doi: 10.1007/s11523-015-0377-6.

Secondary Metastases Resection After Bevacizumab Plus Irinotecan-Based Chemotherapy in First-Line Therapy of Metastatic Colorectal Cancer in a Real-Life Setting: Results of the ETNA Cohort.

Author information

1
University of Bordeaux, F-33000, Bordeaux, France.
2
CIC Bordeaux CIC1401, F-33000, Bordeaux, France.
3
CHU Bordeaux, F-33000, Bordeaux, France. denis.smith@chu-bordeaux.fr.
4
Service d'Oncologie Médicale, CHU de Bordeaux, F-33075, Bordeaux, France. denis.smith@chu-bordeaux.fr.
5
CHU Bordeaux, F-33000, Bordeaux, France.
6
Institut Bergonié, F-33076, Bordeaux, France.
7
CHU Toulouse, F-31059, Toulouse, France.
8
CHU Rouen, F-76031, Rouen, France.
9
CHU Limoges, F-87042, Limoges, France.
10
INSERM, U657, F-33000, Bordeaux, France.

Abstract

PURPOSE:

Resection of metastases after chemotherapy improves survival outcomes of patients with initially inoperable metastatic colorectal cancer (mCRC), yet little data is available for those treated in the first-line setting with bevacizumab plus irinotecan. To provide data on this, the present study described the subgroup of the ETNA cohort who underwent metastases surgery.

METHODS:

The population of operated patients was described according to metastatic site (exclusively hepatic, non-exclusively hepatic, and non-hepatic). Factors associated with overall survival (OS) and progression-free survival (PFS) were evaluated using multivariable Cox analysis.

RESULTS:

A total of 76 patients (21.1 % of the ETNA cohort) underwent metastases resection: 50 % male, median age 61.9 years, 85.5 % ECOG  ≤ 1, and median duration of bevacizumab use 7.2 months. No surgery-related deaths were observed and 30.6 % of patients had at least one post-operative complication, mainly infections (11.8 % of resections), bleeding complications (3.5 %), or delayed wound healing (2.4 %). Complete remission was higher for those with exclusively hepatic metastases (22/32, 68.8 %) than those with non-exclusively hepatic metastases (12/24, 50.0 %), or non-hepatic metastases (12/20, 60.0 %). Among operated patients, 52.6 % had died after 5 years of follow-up. In multivariable analysis at 2 years of follow-up, death (HR 0.09 [95 % CI 0.02-0.35]) and progression (HR 0.35 [95 % CI 0.23-0.56]) were less likely for patients with complete remission (CR) after surgery R0-R1 or radiofrequency ablation (RFA) [CR RFA] compared with those who were not resected or with R2 resection.

CONCLUSION:

In real-life practice, bevacizumab with irinotecan in first-line therapy for mCRC allows secondary resection of metastases and survival is more favourable in those with complete remission (R0-R1/CR RFA).

PMID:
26298481
DOI:
10.1007/s11523-015-0377-6
[Indexed for MEDLINE]

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