Interesting article looking at metastatic CRC in single organs, with liver and lung being the most common sites involved. SIRT and the SIRFLOX trial rate a mention.
For unresectable liver mets: In a large study by Stangl et al[39] that included 484 patients, 189 who did not have extrahepatic metastases had a median survival of 9.6 mo. In this group, patients with a lower volume of liver replaced by tumor and grade 1-2 (primary) disease with no extrahepatic and no mesenteric lymph node involvement had the highest median survival (21.3 mo; range, 5-68 mo; 95%CI: 15.6-34.1). According to these studies, the median survival of patients with CRC metastases confined to the liver with a low disease volume is in the range of 11 to 18 mo; with a higher disease volume, the range is 6 to 8 mo. These studies predate the currently available systemic treatments.
Liver relapse in the SIRT-arm of SIRFLOX were more likely to be new (i.e. smaller volume) lesions compared with the non-SIRT arm in which liver recurrence was more likely to be in the larger pre-existing metastasis.
For unresectable lung mets: In a prospective study of 70 patients with CRC and isolated unresectable lung metastases who were treated with chemotherapy[81], the mOS was 19 mo (95%CI: 12.6-25.4 mo, range: 5-44 mo), with a 2-year OS rate of 38.8%. The first response assessment seemed to be a prognostic factor, with a mOS of 27 mo (95%CI: 23.4-30.6 mo) for patients with a partial response compared with 16 mo (95%CI: 8.3-23.7 mo) and 8 mo (95%CI: 5.2-10.8 mo) in patients with stable disease and disease progression, respectively (P < 0.01).
I'm very happy to see a much larger OS than for unresectable liver mets, even allowing for new chemo regimens introduced since the liver study. Any other studies to support this would be appreciated. Hopefully this will translate to a positive OS result for the mCRC trials next year. It would make the recent SP pullback look very foolish indeed!:):):):D:D:D
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631975/
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