After a patient is diagnosed with colorectal cancer (CRC), the treatment path depends on the extent of disease progression. Patients with peritoneal metastasis (or spread to abdominal cavity) with limited spread, are offered treatment with intent to cure. The standard treatment in this case is a combination of cytoreductive surgery, which is the removal of all sites of cancer within the abdominal cavity, and hyperthermic intraperitoneal chemotherapy, where heated chemotherapy drugs are applied directly inside the abdomen to eliminate the remaining cancerous cells. This treatment, known as CRS-HIPEC, has been shown to be safe and is associated with overall survival rates of 40-50 months.
The line in the sand
Patients that have both peritoneal metastasis and (limited) spread of cancer to other organs are currently offered palliative systemic chemotherapy. This is where the line is drawn between curative and palliative therapies. Patients receiving palliative care have a life expectancy of just 5-16 months. However, emerging evidence pooled from small (and potentially biased) cohort studies suggests that curative therapy may considerably improve survival rates in this group of patients.
Testing the (pooled) waters
Dr. Jurriaan Tuynman and his team at Cancer Center Amsterdam aim to validate the suggestive data from the pooled cohort studies. The team will conduct a clinical trial with the KWF-funded project “Cytoreduction, HIPEC and local treatment for patients with colorectal peritoneal and limited liver/lung metastases; a parallel cluster trial (the OLIPEC study)” (€ 494,987.00), to determine if they can improve survival in those CRC patients with more advanced disease.
“After local treatment with CRS-HIPEC, plus removal of liver and/or lung tumors followed by 3-4 months of systemic chemotherapy, we expect to substantially increase life expectancy and survival rates in these patients,” says Dr. Tuynman.
A multidisciplinary team will assess patients for their eligibility in the study. Their criterion is: metastasis of colorectal cancer within the abdomen combined with four or less liver and/or lung metastases. A minimum of 69 patients will receive the treatment with curative intent. A matched control group of patients receiving standard systemic chemotherapy only, the current standard therapy, will be selected from the Prospective Dutch Colorectal Cancer cohort.
Moving the line
The team will measure patient response to therapy, morbidity, and quality of life. “We hope to demonstrate a significant improvement in overall survival in this group from 15% to 34% after three years, with a cure rate of 10-25%, compared to 0-5% currently. We expect that prolonged survival will accompanied with a limited major morbidity (<40%) and mortality (<5%),” says Dr. Tuynman. “Most importantly, if our hypothesis is validated, this research will allow standard treatment guidelines to be modified to offer future patients a better chance of survival.”
For more information contact:Dr. Jurriaan Tuynman.
Researchers involved in this research project:
Dr. Jurriaan Tuynman (principal investigator)
Dr. Geraldine Vink (Integraal Kankercentrum Nederland)
Prof. Pieter Tanis
Text by Lynita Howie.