Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: A pooled analysis of two randomized trials

Emmanuel Mitry, Anthony L A Fields, Harry Bleiberg, Roberto Labianca, Guillaume Portier, Dongsheng Tu, Donato Nitti, Valter Torri, Dominique Elias, Chris O'Callaghan, Bernard Langer, Giancarlo Martignoni, Olivier Bouché, Franck Lazorthes, Eric Van Cutsem, Laurent Bedenne, Malcolm J. Moore, Philippe Rougier

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Adjuvant systemic chemotherapy administered after surgical resection of colorectal cancer metastases may reduce the risk of recurrence and improve survival, but its benefit has never been demonstrated. Two phase III trials (Fédération Francophone de Cancérologie Digestive [FFCD] Trial 9002 and the European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada Clinical Trials Group/Gruppo Italiano di Valutazione Interventi in Oncologia [ENG] trial) used a similar design and showed a trend favoring adjuvant chemotherapy, but both had to close prematurely because of slow accrual, thus lacking the statistical power to demonstrate the predefined difference in survival. We report here a pooled analysis based on individual data from these two trials. Patients and Methods: After complete resection of colorectal liver or lung metastases, patients were randomly assigned to chemotherapy (CT arm; fluorouracil [FU] 400 mg/m2 administered intravenously [IV] once daily plus DL-leucovorin 200 mg/m 2 [FFCD] x 5 days or FU 370 mg/m2 plus L-leucovorin 100 mg/m2 IV x 5 days [ENG] for six cycles at 28-day intervals) or to surgery alone (S arm). Results: A total of 278 patients (CT, n = 138; S, n = 140) were included in the pooled analysis. Median progression-free survival was 27.9 months in the CT arm as compared with 18.8 months in the S arm (hazard ratio = 1.32; 95% CI, 1.00 to 1.76; P = .058). Median overall survival was 62.2 months in the CT arm compared with 47.3 months in the S arm (hazard ratio = 1.32; 95% CI, 0.95 to 1.82; P = .095). Adjuvant chemotherapy was independently associated with both progression-free survival and overall survival in multivariable analysis. Conclusion: This pooled analysis shows a marginal statistical significance in favor of adjuvant chemotherapy with an FU bolus-based regimen after complete resection of colorectal cancer metastases.

Original languageEnglish
Pages (from-to)4906-4911
Number of pages6
JournalJournal of Clinical Oncology
Volume26
Issue number30
DOIs
Publication statusPublished - Oct 20 2008

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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