Perioperative bevacizumab in the treatment of colorectal cancer in patients with liver metastases

Introduction. Patients with colorectal cancer with metastases in the liver parenchyma may benefit from perioperative chemotherapy with biological agents and operative liver resection. Material and Methods. This prospective, multicenter, non-interventional study included 191 previously untreated patients with metastatic colorectal cancer and potentially resectable or initially unresectable liver metastases who received bevacizumab plus chemotherapy. The safety profile, as well as progression-free-survival, response rate and conversion rate of initially unresectable metastases to resectable were assessed. Results. A total of 40 adverse events were reported in 29/191 patients (15.2%), of which 31 were serious adverse events. Among the serious adverse events, 14 were related to the use of bevacizumab therapy, of which 4 were fatal due to serious adverse events, but only one could be related to bevacizumab therapy. The median progression-free period was 9 months (1 - 28). A high rate of response to the applied therapy, 34.5% and 49%, was recorded in both groups of patients: with initially unresectable and potentially resectable metastases in the liver parenchyma. A significant part of patients with metastatic colorectal cancer and metastases only in the liver parenchyma had a clinical benefit from intensive chemotherapy with bevacizumab (disease control rate of 70%). Conclusion. This study confirmed a favourable safety profile and tolerability in terms of the incidence and severity of adverse and serious adverse events. High rates of resectability in both groups of patients, initially unresectable and potentially resectable, reflect the heterogeneity of criteria in decision making about liver resection and emphasize the need for establishing multisciplinary oncology teams and following the generally accepted criteria.