Dr. Nelson on the Benefit of Primary Tumor Resection in mCRC

Douglas A. Nelson, MD, associate professor in the Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the benefit of primary tumor resection in patients with metastatic colorectal cancer (mCRC).

Primary tumor resection plus chemotherapy does not improve overall survival (OS) versus chemotherapy alone in patients with minimally symptomatic mCRC, according to data from the phase III JCOG1007 (iPACS) trial. These data, which were presented at the 2020 Gastrointestinal Cancers Symposium, provided the first randomized demonstration that primary resection is not beneficial in patients with synchronous unresectable metastases, says Nelson. If a patient is referred to surgery first, which is often the case, it is important to understand that resection is not beneficial and could delay the time to systemic therapy.

At a median follow-up of 22.0 months, the median OS was 25.9 months with primary resection/chemotherapy versus 26.7 months with chemotherapy alone (HR, 1.10; 95% CI, 0.76-1.59; one-sided P =.69). The median progression-free survival was 10.4 months with primary resection/chemotherapy versus 12.1 months with chemotherapy alone (HR, 1.08; 95% CI, 0.77-1.50). Three treatment-related deaths following primary resection due to postoperative complications were reported.