The options are neoadjuvant, adjuvant, or no chemotherapy at all: further data is needed
Bakkers, Simkens and De Hingh from Eindhoven speak directly to an issue that confronts the peritoneal surface oncology team on a daily basis (1). The multidisciplinary team discusses the pros and cons of neoadjuvant, adjuvant or no systemic chemotherapy on nearly every PM patient in the absence of meaningful data. These authors provide the multidisciplinary team with considerable options but conclude that there currently are no answers to these important decisions regarding options for treatment. They start their clinical and laboratory research project by proposing that cytoreductive surgery (CRS) plus HIPEC is a current standard of care for patients with limited PM from colorectal cancer that occur in the absence of systemic spread. Two systematic reviews on precisely this subject failed to provide useful data. The ongoing CAIRO6 Dutch trial randomizes patients treated with CRS and HIPEC to neoadjuvant plus adjuvant chemotherapy versus no systemic chemotherapy. Data from this trial will provide information to greatly assist knowledgeable decisions made by the multidisciplinary team. In the future, molecular subtypes and mutations of colorectal cancer that have well defined response versus resistance to chemotherapy may control the selection of cytotoxic drugs.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Gastrointestinal Oncology for the focused issue “Intraperitoneal Chemotherapy for Peritoneal Metastases: HIPEC, EPIC, NIPEC, PIPAC and More”. The article did not undergo external peer review.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-2020-19). The focused issue was sponsored by the Peritoneal Surface Oncology Group International (PSOGI). Drs. PHS and KVDS served as the unpaid Guest Editors of the focused issue. The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Bakkers C, Simkens GAAM, De Hingh IHJT. Systemic therapy in addition to cytoreduction and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: recent insights from clinical studies and translational research. J Gastrointest Oncol 2021;12:S206-13.
