Ricky A. Sharma, MA, MB, BChir, PhD, of Gray Institute for Radiation Oncology and Biology at the University of Oxford, United Kingdom, formally discussed the paper. He disclosed that he is a co-principal investigator for the FOXFIRE study, which is currently evaluating selective internal radiation therapy.

Dr. Sharma commented on the need to treat colorectal cancer with more than just drugs. “How many modalities are enough? I can tell you, it’s not one,” he said. Despite the approval of more than 70 drugs to treat cancer in the past 15 years, overall progression-free survival has increased only by 2.5 months and overall survival by 2.1 months, he pointed out.

“To improve cure rates, we shouldn’t just think about drugs. The curative modalities for cancer tend to be combinations of treatment,” he added.

Clinical Implications

Dr. Sharma raised the possibility that in SIRFLOX, the lack of a progression-free survival benefit is related to the 40% of patients with metastatic disease outside the liver. “Perhaps because of that burden of extrahepatic disease, we don’t see a signal in progression-free survival, but there is an impressive change in local control. This is a robust result,” he offered, “but it comes at a cost—more neutropenia, thrombocytopenia, and ulcerations or radiation-induced liver complications.”

“Selective internal radiation therapy does have the capacity to improve local control, in combination with FOLFOX, but with slightly higher toxicity,” concluded Dr. Sharma. “We anticipate the subgroup analyses and combined analyses to tell us which patients will benefit most from selective internal radiation therapy.” ■

Disclosure: Dr. Sharma reported no potential conflicts of interest.