Journal
EJSO
Volume 41, Issue 7, Pages 868-874Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejso.2015.03.223
Keywords
Bevacizumab; Cetuximab; Colorectal liver metastases; Histological response; Pattern of tumor destruction; Survival
Funding
- Roche (Vienna, Austria)
- Merck-Serono (Vienna, Austria)
- Sanofi-Aventis (Vienna, Austria)
- Bayer (Vienna, Austria)
- Amgen (Vienna, Austria)
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Aim: We investigated whether the type of antibody [bevacizumab (bev) or cetuximab (cet)] added to neoadjuvant combination chemotherapy before curative liver resection was associated with histological response, the pattern of tumor destruction and clinical outcome in patients with colorectal liver metastases (CLM). Methods: We investigated 138 patients with KRAS wild-type status (codon 12, 13 and 61) who received neoadjuvant chemotherapy including bev (n = 101) or cet (n = 37). The primary endpoint was histological response. Secondary endpoints were necrosis and fibrosis of metastases, radiological response, recurrence-free survival (RFS) and overall survival (OS). Results: Histological response was not significantly different between the two groups (P = 0.19). A significantly higher fraction of patients in the bev group showed necrosis of the metastases of >= 50% (P < 0.001), while a higher fraction of patients in the cet group showed fibrosis of >= 40% (P = 0.030). Radiological response was not significantly different (P = 0.17). Median RFS was significantly shorter in the cet group in univariable analysis (BR 1.59 (95% CI 1.00, 2.51), P = 0.049), but this difference did not remain significant in multivariable analysis (P = 0.45). The 3-year OS rate was not significantly different (P = 0.73). Conclusions: The addition of bevacizumab to combination chemotherapy showed more necrosis but less fibrosis of metastases compared to cetuximab and a trend towards higher histological and radiological response and longer RFS. Further investigations of biological tumor characteristics are required to individualize treatment combinations. (C) 2015 Elsevier Ltd. All rights reserved.
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