Liver-Directed Therapies Increase Survival in metastatic colorectal cancer.

Medscape Medical News from the

American Society of Clinical Oncology (ASCO) 2015 Annual Meeting

Ruesch Center
GI Updates From ASCO 2015
Liver-Directed Therapies Increase Survival in mCRC

Brandon G. Smaglo, MD Disclosures June 12, 2015


At this year's ASCO annual meeting, it was clear that excellent work has been made toward the eradication of cancer, and the world of gastrointestinal (GI) malignancies was no exception. A theme of novel approaches to therapies encompassed the studies presented in the management of GI cancers. It was galvanizing to hear how investigators thought "outside of the box" to find better, more effective, more tolerable ways to treat these diseases.
Liver-Directed Therapy in mCRC Conveys Survival Benefit

One of the most exciting reports on the management of GI cancers was a pair of oral abstracts that addressed the value and timing of liver-directed therapies in the management of unresectable hepatic metastases in patients with colorectal cancers. Options for local therapies are not new, but their true value previously has remained unclear. The indication for such treatment has been focused on disease palliation rather than survival benefit.

To better define the role of liver-directed therapy, Dr Theo Ruers[1] presented a study in which patients with hepatic metastatic disease from colorectal cancer were prospectively and randomly assigned to receive treatment with either chemotherapy alone or chemotherapy augmented by radiofrequency ablation (RFA) to the liver lesions. A statistically significant improvement in overall survival (OS) resulted, with average OS of 45.6 months when the RFA was incorporated into treatment, vs 40.5 months when chemotherapy was used alone; progression-free survival (PFS) was significantly improved in the RFA arm as well.

Separately, Dr Peter Gibbs[2] presented the results of a study in which patients with colorectal cancer that had metastasized to the liver were randomly assigned to receive first-line treatment of chemotherapy alone or chemotherapy along with selective internal radiation therapy (SIRT) to the liver lesions. SIRT consisted of yttrium-90 (Y-90) resin microspheres. Although overall PFS was not statistically improved with the addition of SIRT, median PFS in the liver was significantly and impressively extended in the SIRT arm: PFS was 20.5 months in the SIRT arm vs 12.6 months in the control arm. The OS data are still maturing, but it would be surprising if this robust 8-month improvement in PFS did not to translate into an OS benefit.

In both studies, additional toxicities were limited and reasonable. These studies support the incorporation of liver-directed therapy in the management of hepatic metastatic colorectal cancers and broaden the range of therapies available to patients with these incurable cancers.