Grant: Project Grant

Colorectal cancer is the second leading cause of cancer deaths in Canada. Patients with metastatic colorectal cancer generally have a life expectancy of 24-30 months, however, a small number of patients with metastatic cancer that is confined to the liver could potentially be cured following surgical removal of part of the liver containing metastatic tumors. The standard treatment for most patients with metastatic colorectal cancer is a two-drug regimen with or without a biological agent. Most patients are not candidate for surgery due to a large disease burden. Recent evidence suggests that a triplet chemotherapy regimen, FOLFOXIRI plus bevacizumab is associated with higher rates of shrinkage of metastases. Our study will evaluate the number of cases of patients with liver metastases that convert from unremovable to removable following treatment with FOLFOXIRI-bevacizumab. Furthermore, this study will assess the disease control rate, survival, quality of life and association between various biomarkers including an early response to treatment as measured by imaging study, and curative surgery. Thirty-seven eligible patients considered to be fit to tolerate FOLFOXIRI-bevacizumab by their cancer specialists will be recruited at the two major cancer centers in Saskatchewan. These patients will receive FOLFOXIRI-bevacizumab every two weeks for a total of 12 cycles and will undergo periodic imaging studies. The removability of liver metastases will be assessed by a multidisciplinary team. This study will be impactful to establish a much needed standard chemotherapy regimen for patients with liver-only metastatic colorectal cancer in Canada and to determine the role of early radiographic response to treatment and other biomarkers in predicting patient suitability for curative surgery along with cost-effectiveness of this approach versus conventional chemotherapy. Complete removal of metastases will allow such patients to discontinue chemotherapy and live a normal life.