Adjuvant Therapy after Resection of Hepatic Colorectal Metastases

Excerpt

Improvements in surgery and adjuvant chemotherapy have resulted in increased likelihood of cure in many advanced-stage cancers. This is particularly apparent in the case of hepatic colorectal metastases. Over the last three decades, this has changed from a condition that was not amenable to surgery and was uniformly fatal, to one where patients undergo resection for possible cure in over one third of cases.1 Chemotherapy for colorectal cancer has changed from a single agent consisting of 5-fluorouracil (5FU), to a full armamentarium with oxaliplatin, irinotecan, bevacizumab, and cetuximab.2 The optimal adjuvant regimen, however, is far from certain. The study in this issue by Posner et al.3 examines the use of adjuvant immunotherapy, using monoclonal antibodies directed against carcinoembryonic antigen (CEA) and human milk-fat globule. Though it was a negative phase II trial, the authors should be saluted for the intended approach toward studying adjuvant therapy. The authors intended this trial to be the first of a series of phase II trials of novel agents administered in the adjuvant setting. Given that there was no consensus as to the optimal adjuvant regimen, and that fewer than 5% of oncology patients nationwide are enrolled in clinical trials, the poor accrual found in this study was disappointing. Investigators have to be more active in our existing cooperative oncology groups, to ensure their survival, as this offers the best hope of performing the large multicenter trials necessary to bring proven therapy rapidly to our cancer patients. …