Role of Primary Tumour Resection and Addition of Bevacizumab to Chemotherapy in the Management of Advanced Colorectal Cancer with Inoperable Metastasis: A Retrospective Analysis

• Javier Garde Noguera

  Servicio Oncología Médica, Hospital Arnau de Vilanova de Valencia, Spain

• Elena Evgenyeva

  Servicio de Anatomía Patológica, Hospital Marinasalud de Denia, Spain

• Mireia Gil Raga

  Servicio Oncología Médica, Hospital de Sagunto, Spain

• Asunción Juárez Marroquí

  Servicio Oncología Médica, Hospital de Elda, Spain

• Juan Manuel Gasent Blesa

  Servicio Oncología Médica, Hospital Marinasalud de Denia Spain

• Juan Laforga

  Servicio de Anatomía Patológica, Hospital Marinasalud de Denia, Spain

• Laia Bernet

  Servicio de Anatomía Patológica y Oncología Diagnóstica, Hospital Lluís Alcanyís, Xativa, Spain

• Mónica Clemente Císcar

  Centro de Gestión de la Calidad y el Cambio, Universitat Politécnica de Valencia, Spain

• Carlos Camps Herrero

  Servicio de Oncología Médica, Consorcio Hospital General Universitario de Valencia, Spain

• Antonio Llombart Cussac

  Servicio Oncología Médica, Hospital Arnau de Vilanova de Valencia, Spain

 Purpose:To analyze the impact of primary tumour resection on treatment outcomes in patients with advanced colorectal cancer (CRC) and inoperable metastases at diagnosis in combination with optimal systemic therapy.

Methods:A retrospective study was carried out in four hospitals in Valencia (Spain) including all consecutive patients diagnosed between 1/2009 and 12/2010 of advanced CRC with inoperable metastasis and treated with a fluoropyrimidine and oxaliplatin combination chemotherapy regimens with or without bevacizumab (B). Treatment outcomes were compared between patients undergoing or not primary tumour resection.

Results:A total of 112 patients met inclusion criteria: 62 patients underwent resection of the primary tumour (Group 1) and 50 were treated with exclusive chemotherapy (Group 2). Globally, patients in group 2 presented more disfavorable characteristics. Forty-five (72%) and 31 (62%) patients received chemotherapy with bevacizumab respectively. Overallresponse rate(ORR) were 67% in Group 1 and 56% in Group 2. There were no statistically significant differences between the two groups in progression free survival (PFS) (12 vs. 10 months; p =0.11) and overall survival (OS) (27 vs. 22 months; p 0.1). B regimens increased ORR (73% vs. 42%; p = 0.003) and PFS (12 vs. 11 months; p = 0.019) but not OS. Complications were higher in the group of patients without primary tumour resection, particularly when associated to B regimens.

Conclusions:Primary tumour resection offers no survival gain for patients with advanced CRC and inoperable metastases. Benefits of adding Bevacizumab to standard chemotherapy were similar in both groups, but it increases the risk of complications in non-resected patients.

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