Neoadjuvant chemotherapy for non-/resectable metastases

The identification of patients with resectable and potentially resectable metastatic disease is important. For resectable patients, the superiority of a combined approach has been shown. Mostly, perioperative chemotherapy with FOLFOX as established in the EORTC 40983 trial is recommended; postoperative chemotherapy might be an alternative and is being compared to perioperative treatment in randomised trials. In patients with non-resectable (liver) metastases, response followed by resection is mostly the treatment aim, which can be achieved by multiple regimens. In phase III trials, especially FOLFOXIRI [22] and cetuximab plus doublet (e.g. FOLFIRI [37]) have shown high response rates and increased resection rates compared to the control arm. More intensive schedules are under investigation. Re-evaluation for resectability should be performed at least at three and six months during chemotherapy. Resection is currently recommended as soon as resectability is assumed from imaging, as longer chemotherapy is associated with increased morbidity and complete remission is not generally regarded as the treatment aim. © 2011 Elsevier Ltd.