Colorectal Cancer Coverage from Every Angle
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GI Cancers Symposium 2020: Does Primary Tumor Resection Before Surgery Improve Survival in Advanced Colorectal Cancer?

By: Kayci Reyer
Posted: Thursday, February 13, 2020

Based on research presented at the 2020 Gastrointestinal (GI) Cancers Symposium (Abstract 7) in San Francisco, primary tumor resection prior to chemotherapy was not found to improve outcomes in patients with asymptomatic unresectable stage IV colorectal cancer. The randomized, controlled JCOG1007 trial did not provide evidence of benefit with this strategy, although retrospective analyses had suggested it might yield better outcomes.

According to Yukihide Kanemitsu, MD, of the National Cancer Center Hospital in Tokyo, and colleagues, “[Primary tumor resection] is not recommended for [colorectal cancer] patients with asymptomatic primary tumor and synchronous unresectable metastases.”

The study enrolled 160 patients between June 2012 and April 2019. Participants had asymptomatic primary tumors, a performance status between 0 and 1, and had been diagnosed with colon and upper rectal adenocarcinoma; they also had three or fewer unresectable factors in either the liver, the lungs, distant lymph nodes, or the peritoneum. A total of 78 patients were randomly assigned to receive primary tumor resection followed by a chemotherapy regimen of either CapeOX (capecitabine and oxaliplatin) plus bevacizumab or modified FOLFOX6 (fluorouracil, leucovorin, and oxaliplatin) plus bevacizumab, and 82 patients received chemotherapy alone.

The data and safety monitoring committee called for the early termination of the trial at the first scheduled analysis in September 2019, as just half of the expected events (114/227) had been observed. At a median follow-up of 22 months, the median overall survival was 25.9 months for patients undergoing primary tumor resection versus 26.7 months for those receiving chemotherapy alone. Similarly, progression-free survival was superior in patients receiving chemotherapy alone at 12.1 months versus 10.4 months. Overall, three deaths related to postoperative complications from primary tumor resection were reported.

Disclosure: For full disclosures of the study authors, please visit coi.asco.org.



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