Topics related to neoadjuvant chemotherapy for resectable liver metastases from colorectal cancer

Metastases to the liver from colorectal cancer (CRC) are common, and only a minority of patients are candidates for upfront surgery at the initial diagnosis. Carefully selected patients can achieve long-term survival from surgery with curative intent. Unfortunately, the risk of recurrence remains substantial after liver resection. In order to reduce the risk of relapse and improve the outcomes, the role of neoadjuvant chemotherapy has been assessed for resectable colorectal liver metastases (CRLM) with an improvement in progression-free survival (PFS). In particular, this approach seems to be more beneficial for resectable patients with risk factors associated with unfavorable prognosis. However, controversies still remain as to whether neoadjuvant chemotherapy would bring long-term survival benefit for patients with resectable CRLM, along with the main challenge in identifying those who can benefit greatly from this approach due to lack of well documented selection criteria for patient stratification. In addition, no evidence directly addresses whether targeted agents such as cetuximab and bevacizumab should be offered with chemotherapy in the preoperative setting of resectable patients, despite that these aggressive strategies could result in high response rates. To offer the reader an insight into these complex and unresolved issues we will give an overview of three hot topics related to neoadjuvant chemotherapy for initially resectable CRLM.