The Role of Cetuximab in Hepatic Resection of Metastatic Colorectal Cancer

Introduction

Colorectal cancer (CRC) is the third most frequent type of cancer worldwide. The liver is the principal metastatic site for patients with CRC. For patients with liver-limited disease, the use of hepatic resection offers the greatest chance of disease control and, potentially, cure. There have been major improvements in the outcomes of patients with metastatic colorectal cancer (mCRC) over the past 10–15 years and these have been attributed to more effective chemotherapy as well as increased use of hepatic metastatectomy in selected patients. However, in spite of the striking advances that have been made in the systemic treatment of mCRC, chemotherapy alone is rarely associated with long-term survival. In contrast, in a review of outcomes after resection of colorectal liver metastases from Memorial Sloan-Kettering Cancer Center, the actual cure rate was at least 17% and potentially as high as 25%. For patients with liver-isolated metastases, complete surgical resection is the treatment of choice when feasible. Unfortunately, fewer than 20% of mCRC patients present as candidates for potentially curative surgery.

Abstract

For patients with metastatic colorectal cancer with liver-isolated metastases, complete surgical resection may be associated with long-term survival and is the treatment of choice when feasible. Fewer than 20% of patients present as candidates for potentially curative surgery. Induction chemotherapy, also called “conversion” therapy may make patients with initially unresectable disease amenable to surgery. Cetuximab is a monoclonal antibody that targets the epidermal growth factor receptor (EGFR) and increases the efficacy of systemic standard chemotherapy in wild-type KRAS patients. The addition of cetuximab to chemotherapy may increase the proportion of patients who become eligible for curative resection. It may be a reasonable option to use it in wild-type KRAS patients with liver-limited disease who need to be downstaged to resectability.

Keywords

Metastatic colorectal cancer, cetuximab, EGFR inhibitors, KRAS mutations, liver metastases resection, preoperative therapy, targeted therapy, cure