RESECT: A supportive care pathway for liver REsection following downSizing with chEmotherapy plus Cetuximab in meTastatic colorectal cancer in UK NHS practice


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Hassan Malik1, Amanda Pulfer2, Michael Thompson3
1University Hospital Aintree NHS Trust, Liverpool, UK, 2pH Associates Ltd, Marlow, UK, 3Merck Serono Ltd, Feltham, UK

Background

Cetuximab is funded by the UK NHS for use with chemotherapy as a downsizing treatment for patients with KRAS wild-type metastatic colorectal cancer (mCRC) and previously unresectable liver metastases [1].As outcomes in normal practice can differ from clinical trial results, this retrospective observational study was conducted in 7 UK specialist liver surgical centres to describe the liver resection rate following cetuximab and downsizing chemotherapy and evaluate the health care process by which the treatment was provided in normal practice.

Method

Data were collected in 2012 by retrospectively reviewing medical records of patients with mCRC with metastases confined to the liver, defined locally as unresectable without downsizing therapy at first review by a Hepatobiliary Multi Disciplinary Team (HPB MDT).

Results

Sixty patients were included; 29 (48%) underwent liver resection following cetuximab and chemotherapy, with 17 (28%) achieving a R0 outcome, and a further 7 (12%) R1 outcome, similar to the CELIM study [2]in which 33% had an R0 resection. All patients underwent KRAS testing and all 60 were KRAS wild-type. Median time from blood sampling to KRAS result was 8 days (IQR 7–13) (n=27 with complete dates). Of 41 patients with full dates for first chemotherapy and cetuximab infusions and the KRAS reporting date, 35(85%) started chemotherapy and cetuximab following the KRAS result; only 6(15%) started before it. Median time from first cetuximab infusion to first ‘resectable’ scan result was 12 weeks (IQR 9–17)(n=26 with scans indicating liver resectable). Median time from last cetuximab infusion to liver resection was 15 weeks (IQR 11–18) (n=13 resected, with complete dosing data).

Conclusion

In specialist liver surgical centres, where patients are evaluated and prepared for liver resection, optimal management by HPB MDT using KRAS testing, cetuximab and chemotherapy results in outcomes comparable to those achieved in clinical trials.