Influence of FOLFIRINOX on the achievement of resistability in patients with rectal and liver metastases
G.A. Khakimov (1, 2), Kh.I. Dzhumaniezov (1, 2), Sh.Sh. Kadyrov (1, 2), G.G. Khakimova (3), S.I. Abdulkhuseynova (3), I.N. Poluzhkina (3)
1) Tashkent Pediatric Medical Institute, Course of Oncology and Pediatric Oncology, Tashkent, Uzbekistan;
2) Tashkent City Branch of the Republican Specialized Scientific and Practical Center of Oncology and Radiology, Tashkent, Uzbekistan;
3) N.N. Blokhin National Medical Research Center for Oncology, Moscow, Russia
Background. According to a number of recent publications, the median overall survival (OS) of patients with metastatic colorectal cancer (mCRC) reaches 30 months. Despite the fact that in the treatment of the third most prevalent disease, 3 main drugs with different mechanisms of action are used: fluorouracil, irinotecan and oxaliplatin, there is still no convincing data on the relationship of 3-component chemotherapy and the sequence of the volume of surgical intervention.
Objective. Analysis of the frequency of surgical intervention after the neoadjuvant FOLFIRINOX chemotherapy with an assessment of progression-free survival from the time of treatment and surgical intervention.
Methods. Twenty-two patients (8 women, 14 men) with initially diagnosed mCRC, previously not treated, underwent chemotherapeutic treatment with the neoadjuvant regimen FOLFIRINOX ± bevacizumab/cetuximab. The average age was 58 years (up to 50 years –
6 patients; over 50 years – 16); the functional status of all patients according ECOG was 0–1. In 11 patients primary tumor was localized in the rectum, in 11 – in the colon (in 5 right-sided lesion, in 6 left-sided lesion). All patients had stage IV disease. Of these, T-Tx – in 3,
T1-3 – in 9, T4 – in 10; N-Nx – in 7, N0 – in 3, N+ – in 13 patients. Metastatic lesion was represented mainly by liver metastases –
22 patients (12 of them had isolated liver metastases). In addition to the liver, the following organs of 11 patients were involved: umbilicus –
1 patient, ovaries – 5, bones – 3, lungs – 2 patients.
Results. In the majority of patients (6 patients), neoadjuvant FOLFIRINOX chemotherapy allowed performing simultaneous surgery for both the primary focus and liver metastasis.
Conclusion. The use of FOLFIRINOX in a series of observations should be of particular interest in the neoadjuvant treatment strategy for initially inoperable patients, determining the response rate of the primary tumor or secondary manifestations of the disease and the prognosis of the disease. Further studies on the effects of combination therapy and surgical treatment of patients with CRC and liver metastases are warranted.
Keywords: colorectal cancer, liver metastases, neoadjuvant chemotherapy
About the Autors
Corresponding author: Gulnoza G. Khakimova, Postgraduate Student at the Department of Chemotherapy and Combined Treatment of Malignant Tumors, N.N. Blokhin National Medical Research Center for Oncology, Moscow, Russia; e-mail: firstname.lastname@example.org; ORCID: https://orcid.org/0000-0002-4970-5429, Science index: 6939-8668
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