Choice of chemotherapy before liver metastasis surgery matters for some patients

HOUSTON - Patients and their physicians should be careful when selecting a chemotherapy drug to treat colorectal cancer that has spread to the liver, say researchers at The University of Texas M. D. Anderson Cancer Center in Houston.

While surgery to remove liver metastases also has proven beneficial, both of the most commonly used chemotherapy drugs to treat these tumors can seriously injure the liver the researchers report in the May 1 issue of the Journal of Clinical Oncology. Furthermore the damage caused to the liver by these preoperative chemotherapy regimens can adversely affects long-term surgical outcomes.

Use of chemotherapy before surgery offers several important benefits, including reducing the size of tumors such that they are more easily removed and, potentially doubling the survival rate.

Results of their 13-year study of 406 patients, treated either at M. D. Anderson or at a hospital in Torino, Italy, found that one drug, irinotecan, produced steatohepatitis (an inflamed "fatty" liver) in 20 percent of patients who used it, and three of those patients later died.

Most of these complications were seen in patients who were overweight or who already had a fatty liver, a condition known as steatosis, says lead author Jean-Nicolas Vauthey, M.D., professor in the Department of Surgical Oncology at M. D. Anderson.

"Most patients who use preoperative chemotherapy when their colorectal cancer spreads to the liver do just fine," Vauthey says. "But this study shows us that we need to screen patients in advance and use the drug that is right for them."

The other most commonly used chemotherapy drug, oxaliplatin, produced sinusoidal dilation (swelling and leaking of blood vessels in the liver) in almost 19 percent of patients who used it, but no deaths were associated with this condition.

"Although such serious complications are comparatively rare, our finding that the choice of chemotherapy matters in out

Contact: Stephanie Dedeaux
University of Texas M. D. Anderson Cancer Center

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