The invited discussant of the CAIRO5 presentation at the 2022 ASCO Annual Meeting was Cathy Eng, MD, FACP, FASCO, Professor of Medicine, Hematology, and Oncology at Vanderbilt-Ingram Cancer Center, Nashville. Dr. Eng explained the key questions being asked by the investigators.

“If you have a patient with colorectal cancer and metastases to the liver alone, and the tumor has poor prognostic features—right-sided primary and RAS or BRAF mutation—which chemotherapy regimen is best suited to improve progression-free survival? Which regimen is more likely to result in a successful R0 hepatic resection? And which approach may result in improved overall survival?” she said.

“This was a positive study in favor of FOLFOXIRI [leucovorin, fluorouracil, oxaliplatin, irinotecan] and bevacizumab, with prolonged follow-up [median = 41 months],” she said. “FOLFOXIRI and bevacizumab increased progression-free survival, response rate, R0 resection, and ablation.”

She continued: “For patients who underwent ablation, it was best to receive some type of [surgical] liver intervention if appropriate. And with regard to liver resection, the use of FOLFOXIRI provided an improvement in R0 resection as well as the use of ablation.”

Cathy Eng, MD, FACP, FASCO

Additional Considerations

Dr. Eng was reassured to learn there was no increase in postoperative complications with FOLFOXIRI plus bevacizumab, as earlier data suggested there might be. She also applauded the incorporation of an expert panel of liver surgeons in the study. “The expert liver panel was commendable for its central review, and its use encourages the multidisciplinary management by a tumor board,” she said.

Ultimately, without overall survival data, Dr. Eng was unsure whether superior progression-free survival will be of great benefit in this population, despite resection of liver metastases. As she pointed out: “These patients are at risk for extrahepatic disease, and right-sided tumors historically carry an increased risk of peritoneal disease.” 

DISCLOSURE: Dr. Eng reported relationships with Bayer Health, Gilead/Forty Seven, GlaxoSmithKline, Hookipa Biotech, Mirati Therapeutics, Natera, and Pfizer.