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Surgeon Highlights Regional Therapy Approaches for mCRC

Brandon Scalea
Published: Friday, Feb 08, 2019

Byrne Lee, MD

Byrne Lee, MD

In past years, management of metastatic colorectal cancer (mCRC) has required a more palliative approach, but recent therapeutic advances have improved patient outcomes. Despite this progress, there is still much work left to be done, said Byrne Lee, MD.

at the 2019 State of the Science Summit™ on Gastrointestinal Cancers, Lee further discussed regional treatment strategies for patients with mCRC.

OncLive: What is the use of intraperitoneal chemotherapy and surgery for the treatment of peritoneal metastases for CRC?

Lee: In the past, this has been a deadly disease with a very poor prognosis. Over the years, however, we have been utilizing aggressive cytoreductive and debulking surgeries to rid the peritoneum of disease. We have also included intraperitoneal chemotherapies, which have been shown to improve survival in recent randomized trials. I shared some of the updates that were presented at the 2019 Gastrointestinal Cancers Symposium. There does appear to be an improvement with cytoreductive surgery, but the use of intraperitoneal chemotherapy may or may not improve survival. We definitely need more studies to improve our knowledge on this.

Could you elaborate on some of these studies that were presented at the 2019 Gastrointestinal Cancers Symposium?

There was a study presented in 2018 by a large French group, the long-awaited PRODIGE 7 trial, which looked at the use of cytoreductive surgery with or without HIPEC for the treatment of CRC with peritoneal metastasis. In this trial, patients were randomized to receive either surgery or surgery with HIPEC; this utilized a more European regimen comprised of oxaliplatin perfused for 30 minutes at 43 degrees Celsius. In that trial, there was no improvement in overall survival or progression-free survival (PFS) when HIPEC was used. It did, however, show that cytoreductive surgery works—there was a median PFS of approximately 40 months in both arms, and we have used this study to show that aggressive surgical debulking can help certain patients with peritoneal metastasis.
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