Because patients with isolated liver metastases and no other site of disease may in fact be cured by surgery, delving into the key factors contributing to treatment choice in this setting is critical. In this regard we inquired about a patient with an initially resectable lesion who goes directly to surgery. In this situation, more than 80% of GOs employ some type of “pseudoadjuvant” systemic treatment, and a substantial minority include a biologic, usually bevacizumab. The faculty, however, favor FOLFOX without a biologic for these patients.

Nordlinger B et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): Long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 2013;14(12):1208-15. Abstract

Allegra CJ et al. Phase III trial assessing bevacizumab in stages II and III carcinoma of the colon: Results of NSABP protocol C-08. J Clin Oncol 2011;29(1):11-6. Abstract

Stein A, Schmoll JH. Systemic treatment of liver metastases from colorectal cancer. Ther Adv Med Oncol 2013;5(3):193-203. Abstract