Clinical

New CD guides management of liver metastases from colorectal cancer

Last Updated: 2004-11-04 14:58:32 -0400 (Reuters Health)

By Larry Schuster

VIENNA (REUTERS HEALTH) - An international multidisciplinary expert panel has launched a decision model to assist surgeons and medical oncologists in defining treatment for patients with liver metastases from colorectal cancer.

The OncoSurge decision model was produced on a fully integrated multimedia CR Rom, developed by 16 surgeons, oncologists and radiologists from North American and Europe. It is based on data from the literature, expert panel consensus detection techniques and the expertise of the world's leading practitioners and researchers.

Dr. Graeme Poston, of the Royal Liverpool University Hospital, and president-elect of the British Association of Surgical Oncology, and colleagues presented a report on the model at the 29th European Society of Medical Oncology Congress, where the program was launched.

For management of liver metastases from colorectal cancer, they note, "surgery is the only potentially curative treatment with a 5-year survival of 20% to 35%. Only about 20% of patients are initially resectable." Neoadjuvant combination chemotherapy can increase this by 10% to 20%, but "no published consensus on appropriate treatment strategies exists."

Clinical trial results on relevant therapies are ongoing, but years away, Dr. Poston noted. In response, the 16 experts developed the model using the RAND/UCLA Appropriateness Method. The model considers potentially thousands of combinations of risk factors, and identifies and individualizes the patient's resectability and makes recommendations for optimal treatment strategies of colorectal liver metastases.

The model indicates appropriate procedures for which the health benefits exceed the expected negative consequences, as well as "uncertain procedures," for which benefits and risks are about equal or the panel members disagree.

In a statement issued along with the CD, Dr. Poston said previous applications of similar methodology have accurately predicted the outcome of ongoing clinical trials by as much as 90%.

Dr. Norman Wolmark, chairman and principal investigator of the National Surgical Adjuvant Breast and Bowel Project, told Reuters Health that the decision model was constructed in a "painstaking way, getting the Rand Corporation involved. I think they went about it in a methodic, step-wise way."

"Our member surgeons are enthusiastic about it, the ones we come into contact with at the NSABP," he continued. "We're having a symposium before the next NSABP meeting next week to really feature the model."

The decision model was produced by Evidis with an unrestricted educational grant from Sanofi-Synthelabo.

Launch of the decision model follows the latest marketing approval for oxaliplatin, one of the key components featured in the decision model. In September, it received European marketing approval for the adjuvant treatment of stage III colon cancer in combination with 5-fluorouracil/leucovorin. Approval for adjuvant use in the United States is expected shortly.