Dr. Boland on Determining When to Utilize Up-front Perioperative Chemotherapy in CRC

Patrick Boland, MD, medical oncologist, member, Gastrointestinal Oncology team, Rutgers Cancer Institute of New Jersey, RWJBarnabas Health, discusses determining when to utilize up-front perioperative chemotherapy for patients with colorectal cancer (CRC) with liver metastases.

Initial considerations for up-front treatment selection in patients with CRC include assessing disease involvement in the liver, Boland says. Additionally, it is important to determine whether the patient’s disease is synchronous or metachronous. Mutational status is also important to assess because the presence of RAS and BRAF mutations confers poor prognosis, Boland explains. It is also critical to determine whether the primary tumor is intact or resected and whether it is node positive, Boland adds.

Although data are not conclusive as to whether up-front perioperative chemotherapy improves long-term outcomes, it is the preferred treatment regimen for patients with high-risk disease, even if they are resectable, Boland explains. However, it is important to try to limit the chemotherapy to 2 to 3 months and implement frequent scans ever 6 to 8 weeks to reassess the tumors.

Notably, this method requires up-front visitation to a hepatobiliary surgeon to determine whether techniques such as portal vein embolization can be employed, Boland concludes.