You are here: Home: CCU 4 | 2006: Nicholas J Petrelli, MD

Tracks 1-14

Track 1 Introduction Track 2 Evaluating resectability of hepatic metastases Track 3 Utility of radiofrequency ablation for hepatic metastases Track 4 NSABP-C-09: CAPOX with hepatic arterial infusion of FUDR versus CAPOX for patients with resected or ablated hepatic metastases Track 5 Quality control among surgical oncologists treating colon cancer Track 6 Combined-modality preoperative chemoradiation therapy for rectal cancer Track 7 Clinical evaluation and staging of rectal cancer Track 8 Evaluation of patient suitability for abdominal perineal resection Track 9 NSABP-R-04: Preoperative radiation therapy and capecitabine with or without oxaliplatin or continuous infusion 5-FU with or without oxaliplatin in rectal cancer Track 10 Surgical considerations in open versus laparoscopic colectomy Track 11 Factors related to the adequacy of nodal sampling Track 12 Multimodality management of early colon cancer Track 13 NSABP-C-10 trial for patients with synchronous primary and metastatic disease Track 14 Treatment of patients presenting with both primary and resectable metastatic disease

Select Excerpts from the Interview

Track 2

DR PETRELLI: When patients come to me for a possible liver resection, I’m looking for a reason not to operate. You need to ascertain whether the disease in their liver looks like resectable disease, which depends on the size and number of lesions. But the most important question is, does the patient have any evidence of extrahepatic disease?

In my mind and I think most of my colleagues’ minds — although a shift is occurring — extrahepatic disease is a contraindication to resection outside any type of protocol. I know an undercurrent exists, because of the new agents, to take patients with extrahepatic disease and resect their primary tumor along with their liver disease, but I believe that should be done as part of a clinical trial.

DR LOVE: Can you talk about those patients with disease you consider unresectable at the moment but that has the potential for resectability?

DR PETRELLI: Those patients need a true multidisciplinary approach to their disease. They must have input from the surgeon and the medical oncologist. Those individuals will likely be treated up front with FOLFOX and bevacizumab. They have to be followed closely because a window of opportunity will arise when those cases are converted from unresectable to resectable. Constant communication is necessary between the medical and surgical oncologists. After the first two cycles, the patient should be reevaluated to determine if the disease has become resectable.

Track 9

DR PETRELLI: I believe NSABP-R-04 is a very important study. It goes back to the issue of a prospective, randomized, multicenter trial. I’ve been in this business long enough to know that data from a single-institution trial have to be reproduced.

I believe the addition of oxaliplatin is important, and it didn’t increase the target accrual because we’re talking about a noninferiority trial for the capecitabine versus continuous infusion 5-FU comparison. The accrual has been going very well for NSABP-R-04, even before oxaliplatin was added.

DR LOVE: If capecitabine is equivalent to infusional 5-FU, it will be a big boost to the patient in terms of avoiding the pump, et cetera.

DR PETRELLI: Sure. It’s a good quality-of-life question.

Track 13

DR PETRELLI: NSABP-C-10 is a Phase II trial for patients who present with endoscopically detected, asymptomatic primary colon cancer and unresectable distant metastases (2.1). This trial evaluates the hypothesis that by treating those patients with chemotherapy and bevacizumab, you don’t have to remove the primary tumor. I believe that’s a very provocative and practical question because about 60 percent of these patients, according to SEER data, are having their primary tumors removed (Cook 2005).

The primary aim of the study is to observe the incidence of obstruction, perforation, fistula formation and hemorrhage that requires surgery. The secondary aim is to assess those potential complications with which the patient may not require surgery but needs hospitalization.

DR LOVE: If you see that the patients respond well with very low rates of local complications, what do you think will be the next step?

DR PETRELLI: If we see what you describe, I don’t believe we’ll have to do a Phase III trial. I believe we could probably state that if a patient presents with an asymptomatic primary tumor in the colon, not the rectum, you don’t have to worry about removing the primary tumor.

In this Phase II trial, a small number of patients will probably receive chemotherapy and their liver disease will become resectable. I wouldn’t be surprised if we saw some of those patients undergoing a resection of both their primary and distant disease.

Select publications

Home

Editor:
Neil Love, MD

Interviews:

Mace Rothenberg, MD
- Select publications

Nicholas J Petrelli, MD
- Select publications

Paulo M Hoff, MD
- Select publications

Steven R Alberts, MD
- Select publications

A CME Audio Series
and Activity

Faculty Disclosures

Editor's office