Do we need biologic agents in preoperative systemic therapy of liver metastases?

Liver metastases from colorectal cancer are common in patients who present with an initial diagnosis of metastatic disease or in those with recurrence. Without treatment, patients with metastatic disease have a poor prognosis. However, with surgical resection of the metastases, many patients may have the opportunity for long-term survival. The use of chemotherapy in patients undergoing surgery has augmented the long-term survival benefits that are gained with surgery. The use of preoperative chemotherapy may convert a portion of initially unresectable liver metastases to resectable ones. A growing body of literature is helping to define the role of chemotherapy in this setting. The introduction of newer biologic agents (eg, cetuximab and bevacizumab) has led to meaningful improvements in response rates and survival for metastatic colorectal cancer patients. However, further trials are required to better determine the benefits of chemotherapy and biologic agents in the management of patients with liver metastases.