Adjuvant systemic chemotherapy administered after surgical resection of colorectal cancer metastases may reduce the risk of recurrence and improve survival, but its benefit has never been demonstrated.
Dr Emmanuel Mitry and colleagues from Italy evaluated 2 large randomized trials.
The 2 phase 3 trials included Fédération Francophone de Cancérologie Digestive Trial 9002, and the European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada Clinical Trials Group/Gruppo Italiano di Valutazione Interventi in Oncologia trial.
These trials used a similar design and showed a trend favoring adjuvant chemotherapy.
Both trials had to close prematurely because of slow accrual, thus lacking the statistical power to demonstrate the predefined difference in survival.
The research team report a pooled analysis based on individual data from these 2 trials.
After complete resection of colorectal liver or lung metastases, patients were randomly assigned to chemotherapy.
|Overall survival was 62 months in the computed tomography arm|
|Journal of Clinical Oncology|
A total of 278 patients were included in the pooled analysis.
Median progression-free survival was 28 months in the computed tomography arm as compared with 19 months in the surgery alone arm.
The researchers found that the median overall survival was 62 months in the computed tomography arm compared with 47 months in the surgery alone arm.
Adjuvant chemotherapy was independently associated with both progression-free survival, and overall survival in multivariable analysis.
Dr Mitry’s team concludes, “This pooled analysis shows a marginal statistical significance in favor of adjuvant chemotherapy with an fluorouracil bolus–based regimen after complete resection of colorectal cancer metastases.”