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Preoperative Versus Postoperative Chemotherapy With CAPOX Plus Bevacizumab for Resectable Colorectal Liver
Yuji Takakura1, Katsunori Shinozaki2, Satoshi Ikeda1
1Department of Gastroenterological and Transplant Surgery Hiroshima Prefectural Hospital Hiroshima Japan.
Aim:
NCCN and ESMO guidelines recommend up to 6 months of perioperative oxaliplatin-based chemotherapy for patients with resectable colorectal liver metastases (CRLM). However, the optimal sequencing and chemotherapy regimen remain unclear.
Methods:
We conducted a randomized phase II trial, HiSCO-01, to compare the outcomes of preoperative (Preop-group) and postoperative chemotherapy (Postop-group) with eight cycles of CAPOX plus bevacizumab (CAPOX-Bev) in patients with resectable CRLM. The primary endpoint was the treatment compliance rate (TCR), defined as the percentage of patients who received at least six cycles of CAPOX-Bev and underwent R0 resection.
Results:
Of the 81 patients enrolled, 76 patients were eligible. TCR was 89.2% in Preop-group and 71.8% in Postop-group (p = 0.06). The overall incidence of chemotherapy-related Grade 3 or higher adverse events was similar between the two groups. The postoperative complication rate was comparable except that biliary fistula developed significantly higher in Postop-group. The 3-year progression-free survival and 5-year overall survival rates were 32.2% and 60.5% in Preop-group, respectively, and 38.5% and 57.2% in Postop-group, respectively.
Conclusion:
Both preoperative and postoperative CAPOX-Bev were safely administered, and preoperative chemotherapy showed numerically higher TCR than postoperative chemotherapy. This multimodal approach is highly promising for treating resectable CRLM.
Trial Registration:
UMIN Clinical Trial Registry: UMIN000003783.
