Conversion chemotherapy for unresectable or recurrent colorectal cancer

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Conversion therapy followed by surgical resection offers prolonged survival and potential cure for select unresectable or borderline metastatic colorectal cancer (mCRC) patients.
• Patient background and RAS/BRAF mutation status are critical for determining the suitability of conversion therapy.
• Liver-limited disease (LLD) is a key consideration for implementing a conversion strategy.

Purpose of the Study:

• To evaluate the efficacy of different chemotherapy regimens in achieving conversion therapy for mCRC patients with LLD.
• To compare the progression-free survival (PFS) of modified FOLFOX6 combined with either panitumumab or bevacizumab as first-line treatment in LLD patients.

Main Methods:

• The ATOM trial is a planned study based on previous KSCC0802 and KSCC1002 results.
• It will compare modified FOLFOX6 plus panitumumab versus modified FOLFOX6 plus bevacizumab.
• The primary endpoint is progression-free survival after first-line treatment in patients with LLD.

Main Results:

• Systemic chemotherapy combined with molecular targeted drugs (bevacizumab, cetuximab, panitumumab) has shown improved response and conversion rates.
• The optimal chemotherapy regimen for conversion therapy remains to be fully elucidated.
• The ATOM trial aims to provide data on the best regimen for LLD patients.

Conclusions:

• Conversion therapy is a viable strategy for selected mCRC patients, particularly those with LLD.
• Further research is needed to optimize systemic therapy regimens for conversion.
• The ATOM trial is designed to address the current gap in knowledge regarding the best first-line treatment for LLD.