Category: Medical Oncology — Metastatic Colorectal Cancer (liver + peritoneum)
Colorectal cancer spread to the liver and peritoneum… When the surgeon says ‘not resectable yet’, why is conversion therapy still an important hope?
AI Overview / Quick Answer (BLUF)
Liver and peritoneal recurrence within months of oxaliplatin-based chemo signals resistance to that drug mechanism,
so the team switches backbone (usually FOLFIRI ± a biomarker-matched biologic). The main goal is disease control;
scans every 2–3 months show whether the MDT can reconsider surgery — possible, but less likely than with liver-only spread
(ESMO mCRC 2023).
How this page differs from our other guides (read together)
- This page focuses on liver + peritoneal disease together that recurred early after oxaliplatin-based therapy — PCI scoring, CRS ± HIPEC, and realistic second-line conversion odds.
- Liver-only spread, conversion basics, interventional radiology (TACE / MWA / SIRT), and referral paperwork → Unresectable colorectal liver metastases: conversion therapy and interventional radiology (Thai)
- Second-line regimens, biomarkers, and third-line options in detail → Colorectal cancer spread to the lungs: second-line therapy and fighting on
- First-line therapy and stage 4 disease control → Stage 4 colon cancer: first-line chemotherapy, targeted therapy, and disease control
Red flags — go to the emergency department or call your cancer team now
- Yellow eyes or skin, tea-colored urine, or pale stools — possible bile duct blockage or declining liver function
- Rapidly increasing abdominal size, tightness, or fast weight gain despite eating little — possible fluid in the abdomen (ascites) from peritoneal disease
- Repeated vomiting, a bloated tight abdomen, cramping waves of pain, and no gas or stool passing — suspected bowel obstruction from peritoneal disease
- Sudden severe abdominal pain, a rigid abdomen, or pain so bad you cannot move
- Fever of ≥38.0°C during chemotherapy, or shaking chills — suspected febrile neutropenia
- Severe diarrhea after irinotecan (≥4–6 more stools per day than usual, continuous watery stools) — start the loperamide plan your team gave you and call the team immediately, especially with fever, dizziness, or low urine output
- Confusion, drowsiness, incoherent speech, or unusual sleepiness — may relate to the liver, electrolytes, or infection
- Bleeding that will not stop, vomiting blood, black stools, or many new bruises
- Chest pain, sudden breathlessness, or one-sided leg swelling — suspected blood clot
1. What does “not resectable yet” mean when disease is in both the liver and the peritoneum?
Direct answer: Not resectable yet means that today the surgeons cannot remove every tumor site completely (R0) and safely
— it is not a permanent verdict. The team starts systemic therapy first and brings the images back to the multidisciplinary meeting (MDT) when tumors respond
(NCCN Colon Cancer).
What liver surgeons look at
- Every liver tumor can be removed with cancer-free margins (R0)
- Enough functional liver will remain (future liver remnant, FLR) — typically at least about 20% of a normal liver and about 30% after extensive chemotherapy
- Inflow and outflow vessels and bile drainage of the remaining liver can be preserved
- Disease outside the liver (including the peritoneum) is controlled or can be removed completely in the same plan
- Performance status and other illnesses allow major surgery
Why peritoneal disease makes the path harder
The peritoneum is a large surface, small deposits are often invisible on CT, and their blood supply is poor, which limits how well systemic drugs reach them.
Pooled patient data from several randomized trials (ARCAD) found shorter median survival with peritoneal metastases than without (about 16.3 vs 19.1 months)
(Franko J, Lancet Oncol 2016)
— so evaluation belongs at a centre with both hepatobiliary and peritoneal surgeons.
2. What early recurrence (within 6–12 months of oxaliplatin) tells you and how it changes drug choice
Direct answer: Disease that returns during or within about 6 months after finishing oxaliplatin-containing therapy is usually treated as oxaliplatin-resistant,
so the team rarely reuses oxaliplatin now and switches to an irinotecan backbone — early relapse also signals aggressive biology, so the team wants to see a response before major surgery
(ESMO mCRC 2023).
What it means biologically
- Cells resistant to the previous drugs survived and grew (acquired / primary resistance) — it does not mean the patient “didn’t fight enough” or that the team made a mistake
- Many teams apply a “test of time” — about 2–3 months of the new regimen first, to confirm no new lesions appear before committing to a large, risky operation
- Fifteen cycles of oxaliplatin may leave numbness in the hands and feet (neuropathy) — another reason not to repeat the same drug; describe your symptoms honestly to the team
- Having tolerated chemo well helps you receive treatment on schedule and at full planned dose — an advantage, but not a guarantee that tumors will respond to the new drugs
3. Conversion therapy, realistically: where the 60–70% figure comes from and how this situation differs
Direct answer: The often-quoted response rate of about 60–70% comes from first-line treatment of liver-limited disease,
mostly RAS wild-type tumors treated with anti-EGFR antibodies, as in the CELIM trial
(Folprecht G, Lancet Oncol 2010)
— but in second-line treatment after early relapse, trials report overall response rates of roughly 5–35% depending on regimen and biomarkers,
and later surgery is less frequent, especially when peritoneal disease is present.
Data graph: tumor response rate (%) — first-line liver-limited vs second-line
First-line, liver-only (reference only) Control arm Study drug arm
(e.g. ML18147 median survival 11.2 vs 9.8 months;
Bennouna J, Lancet Oncol 2013).
The realistic goal in this situation
- Primary goal: disease control, longer life, and quality of life
- Secondary goal: if tumors shrink clearly with no new lesions — open a “window” for the team to reassess liver resection, peritoneal cytoreduction, or liver ablation
- In a large liver-surgery series, about 1 in 8 patients with initially unresectable liver metastases later reached surgery with chemotherapy (mostly first-line, liver-only)
(Adam R, Ann Surg 2004) — with second-line therapy and peritoneal disease, this figure is expected to be lower
Comparison table: conversion-intent vs disease-control systemic therapy
| Aspect | Conversion intent (aiming for surgery / local treatment) | Disease-control intent (palliative-intent) |
|---|---|---|
| Goal | Shrink tumors enough to remove or ablate them completely (R0 / CC-0) | Stop growth, extend life, control symptoms, protect quality of life |
| Regimen intensity | Often the regimen with the highest shrinkage chance the body can handle (2–3 chemo drugs + biomarker-matched biologic) | Balances efficacy with side effects; may de-escalate or use maintenance once controlled |
| Re-imaging | Chest-abdomen CT ± liver MRI about every 2–3 months (often after 4–6 two-weekly cycles) | CT about every 2–3 months, or sooner with new symptoms |
| Surgical re-evaluation | Case reviewed at the MDT after every scan, with liver and peritoneal surgeons | Reviewed if response is better than expected, or if surgery can relieve a symptom (e.g. bowel obstruction) |
| Anti-VEGF timing | Bevacizumab usually stopped about 6 weeks before major surgery and restarted once the wound has healed (at least about 4–6 weeks) | Continued as planned with monitoring of blood pressure, urine protein, and bleeding |
| Liver and number of cycles | Teams aim to operate as soon as resectable rather than prolonging chemo (more cycles increase liver injury) | Continued until progression or unacceptable toxicity, with liver tests every cycle |
| Typical realistic outcome | A minority reach surgery in second line with peritoneal disease; some fully resected patients stay in remission for long periods, but recurrence is common | Disease control for months to years, then switch to the next line (third-line options exist) |
The two intents are not separate boxes — many people start with disease-control intent and move to conversion intent when tumors respond better than expected.
Starting a new regimen — do these symptoms need a call to the team?
Assess your severity level and receive personalized guidance from our Advisory team.
4. Choosing drugs after oxaliplatin resistance: irinotecan backbone + biomarker-matched biologic
Direct answer: When disease returns early after oxaliplatin, a common second-line choice is FOLFIRI (irinotecan + 5-FU/leucovorin)
plus an anti-VEGF agent, or an anti-EGFR antibody only if RAS/BRAF are wild-type and it has not been used before — BRAF V600E, MSI-H/dMMR, and HER2 amplification have mechanism-matched drugs
(second- and third-line detail: colorectal cancer second-line guide).
| Regimen / drug class | Mechanism | Approximate response rate (source) | Considerations |
|---|---|---|---|
| FOLFOX + anti-EGFR (first-line — for comparison only) | Oxaliplatin cross-links DNA + EGFR signal blockade | About 68% in first-line, liver-only disease (CELIM) — not a second-line figure | If disease returned within 6 months of oxaliplatin, usually not reused; oxaliplatin is linked to sinusoidal obstruction liver injury (“blue liver”) |
| FOLFIRI + bevacizumab (continued beyond progression) | Irinotecan inhibits topoisomerase I + VEGF blockade reduces new tumor vessels | About 5.4% vs 3.9% (ML18147) — its strength is longer survival, not shrinkage | Independent of RAS; stop bevacizumab about 6 weeks before major surgery; irinotecan is linked to steatohepatitis |
| FOLFIRI + aflibercept | Traps VEGF-A, VEGF-B, and PlGF | About 19.8% vs 11.1% (VELOUR) | Hypertension, urine protein, delayed wound healing — plan surgical timing as with other anti-VEGF agents |
| FOLFIRI + ramucirumab | Blocks the VEGFR-2 receptor | About 13.4% vs 12.5% (RAISE) | Main benefit is longer survival (median 13.3 vs 11.7 months); precautions similar to anti-VEGF agents |
| FOLFIRI + anti-EGFR (cetuximab / panitumumab) | Blocks the EGFR receptor on cancer cells | About 35% vs 10% in KRAS wild-type, second line (Peeters 2010) | Requires RAS and BRAF wild-type and no prior use; left-sided primaries tend to benefit more; acne-like rash — no wound-healing issue like anti-VEGF |
| Encorafenib + anti-EGFR (BRAF V600E) | Blocks BRAF and EGFR together to prevent feedback reactivation | About 20% vs 2% in the control arm (BEACON) | BRAF V600E occurs in about 8–10% and is often aggressive — teams are cautious about major surgery until a clear response is seen |
| Immunotherapy (MSI-H / dMMR) | Releases the PD-1 (± CTLA-4) brake so immunity recognizes neoantigen-rich cells | About 44% in first line (KEYNOTE-177, pembrolizumab) | Found in about 4–5% of metastatic cases; if MSI/MMR was never tested, ask — it can change the whole plan |
| HER2-targeted therapy (HER2 amplification) | Blocks HER2 signaling (e.g. trastuzumab + tucatinib or trastuzumab deruxtecan) | Mostly phase 2 data; figures vary by study | Found in about 2–5%, usually RAS wild-type; drug availability and coverage vary by health system |
Figures are group response rates from trials with different eligibility criteria and cannot be compared head-to-head — use them to understand the landscape, not to predict an individual result.
Results to know before starting a new regimen
- RAS (KRAS/NRAS) and BRAF V600E — decide whether anti-EGFR antibodies can be used and whether encorafenib is an option
- MSI / MMR — if MSI-H/dMMR, immunotherapy may change the entire pathway
- HER2 amplification — an additional option in RAS wild-type disease
- Primary tumor side (left/right) and every drug previously received — used together to choose the biologic
and restart after the wound has healed — one reason drug and surgical plans must be made together.
5. Evaluating the peritoneum: PCI score, imaging limits, laparoscopy, and CRS ± HIPEC
Direct answer: Teams measure peritoneal disease with the Peritoneal Cancer Index (PCI) — the lower the score and the more completely it can be removed, the more likely cytoreductive surgery (CRS) helps.
Adding oxaliplatin HIPEC did not improve survival in the randomized PRODIGE 7 trial
(Quénet F, Lancet Oncol 2021).
What the PCI score is
- The abdomen is divided into 13 regions (9 abdominopelvic regions + 4 small-bowel segments); the largest deposit in each region scores 0–3
- 0 = none · 1 = ≤0.5 cm · 2 = ≤5 cm · 3 = >5 cm or confluent → total 0–39
(Jacquet P, Sugarbaker PH 1996) - In colorectal cancer, many centres consider CRS when PCI is low (often no more than about 15–20) and complete cytoreduction (CC-0) is expected; PRODIGE 7 enrolled only PCI ≤25
- Involvement of the small bowel and mesentery is often decisive even with a modest total score, because it is hard to remove
Why CT / MRI / PET-CT may underestimate disease
- CT often misses deposits smaller than about 5 mm and frequently underestimates the PCI found at surgery
(PubMed — CT vs surgical PCI) - Diffusion-weighted MRI helps more at centres with expert radiologists
- PET-CT helps find disease outside the abdomen but is insensitive to small and mucinous deposits
Diagnostic laparoscopy
Before major surgery, some centres perform laparoscopy to count the PCI directly and inspect the small bowel — avoiding an open operation that finds disease cannot be removed.
After previous open abdominal surgery, adhesions may limit the view; the team chooses the approach case by case.
CRS ± HIPEC: the honest evidence
- Verwaal randomized trial: CRS + HIPEC with systemic chemotherapy gave median survival of 22.3 vs 12.6 months compared with systemic chemotherapy + palliative surgery (pre-biologic era)
(Verwaal VJ, J Clin Oncol 2003) - PRODIGE 7 (265 patients, PCI ≤25): CRS + 30-minute oxaliplatin HIPEC median survival 41.7 months vs CRS alone 41.2 months —
no difference, but more severe complications at 60 days (about 26% vs 15%) - Current takeaway: complete CRS for limited peritoneal disease at an experienced centre has a role;
HIPEC (with other drugs such as mitomycin C) is used differently across centres or within trials
Combined liver + peritoneal surgery — who might qualify
- Low PCI (many centres use roughly no more than 10–15 when liver disease is also present) and complete removal is feasible
- Few liver lesions (often no more than about 3) that can be resected or ablated completely with enough liver remaining
- Disease responding or stable on systemic therapy, no new lesions during treatment, and no uncontrolled disease outside the abdomen
- Fit enough for a long operation and several weeks of recovery
6. Protecting the liver and body during treatment: chemo liver injury, protein, and herbs
Direct answer: Some chemotherapy drugs injure liver tissue — oxaliplatin is linked to sinusoidal obstruction (“blue liver”)
and irinotecan to steatohepatitis, both raising risk at liver surgery — so teams check liver tests every cycle and avoid prolonging pre-operative chemo
(Karoui M, Ann Surg 2006).
Chemotherapy-associated liver injury
- Oxaliplatin → sinusoidal obstruction syndrome — congested liver capillaries and a blue-purple liver at surgery, seen in about half of oxaliplatin-treated patients in some series
(Rubbia-Brandt L, Ann Oncol 2004) - Irinotecan → steatohepatitis — more common with excess weight or pre-existing fatty liver, and linked to complications after liver resection
(Vauthey JN, J Clin Oncol 2006) - Number of cycles before surgery — patients receiving more than about 6 cycles before liver resection had more post-operative complications, so teams re-evaluate for surgery as soon as the response is sufficient (the team decides the cycle count)
- Tests often checked before each cycle: bilirubin, AST/ALT, ALP, albumin, platelets, and CBC — irinotecan must be adjusted or delayed when bilirubin is high
Nutrition: targets with numbers
- Protein about 1.0–1.5 g/kg/day if kidney function is normal (55 kg ≈ 55–80 g/day) and energy about 25–30 kcal/kg/day, per ESPEN guidance
(Arends J, Clin Nutr 2017) - Eating clean, well-cooked food is already a good foundation — during low white-cell periods avoid raw, fermented, and leftover food
- Weigh weekly; if weight drops ≥5% in 1–3 months or you eat less than half your usual intake for more than a week, ask to see a dietitian
(see colorectal cancer nutrition and cachexia guide) - If peritoneal disease makes you bloat easily, eat 5–6 small meals, chew well, and limit very coarse fiber as the team advises
- Avoid alcohol — it adds direct strain on the liver
“Liver detox / liver tonic” herbs — what to know
- There is no evidence that any herb or food “repairs” or “detoxifies” the liver in a way that controls cancer — good food helps you tolerate treatment but does not treat the liver directly
- Some are themselves liver-toxic, such as high-dose green tea extract, and liver injury has been reported with concentrated turmeric supplements
- Some change drug levels, such as St John’s wort speeding the breakdown of irinotecan and lowering its active levels
- Tell the team about every herb, vitamin, and supplement — including those brought by relatives or friends
Side-effect plans for the new regimen
- Irinotecan, acute (within 24 hours): sweating, excess saliva, cramps, diarrhea — tell the nurse during the infusion; the team has an antidote (e.g. atropine)
- Irinotecan, delayed (often days 3–10): diarrhea — start loperamide as your team instructed, sip oral rehydration solution, and call the team if not better within 24 hours or if you have fever
- Some hospitals test UGT1A1 before irinotecan because certain variants (seen in Asian populations) raise the risk of diarrhea and low white counts
- Anti-VEGF agents: check blood pressure at home, test urine protein as scheduled, report nosebleeds or slow-healing wounds
- Anti-EGFR agents: acne-like rash, dry skin, nail inflammation — use sunscreen and moisturizer from day one
7. How to talk with the multidisciplinary team (MDT) and get answers you can decide on
Direct answer: The decision on combined liver + peritoneal surgery should come from an MDT meeting with hepatobiliary surgeons, peritoneal surgeons, oncologists, and radiologists.
The home hospital can often continue chemotherapy while a university referral centre reassesses surgery when scans respond — the two can work as a pair.
Questions to prepare
- What is the main reason it is not resectable now — number/location of liver lesions, remaining liver volume, or peritoneal burden (roughly what PCI)?
- What kind of response would make the team reconsider surgery or liver ablation?
- When will we re-image (after how many cycles), and how do we send the scans back to the surgical centre?
- What are my RAS, BRAF, MSI/MMR, and HER2 results? If not tested, can the original tissue be used?
- If an anti-VEGF agent is used, how will it be paused if surgery becomes possible?
- Should I have diagnostic laparoscopy or a liver MRI?
- Are there clinical trials I can join, and which drugs are covered by my health scheme?
Referral centres and second opinions
- Centres with hepatobiliary and peritoneal surgery teams are usually university or tertiary hospitals — for example, Srinagarind Hospital (Faculty of Medicine, Khon Kaen University) is one example of a university referral centre in Thailand
- Asking for a second opinion is normal and does not mean distrusting your current team — bring CT/MRI image files, pathology, biomarker results, and a summary of previous treatment
- Referral steps and coverage (Thai context): unresectable colorectal liver metastases guide (Thai) and colorectal cancer costs under Thailand’s universal coverage
8. After fighting through 15 cycles, the cancer returned in 3 months — these feelings are normal, and support exists
Direct answer: Disappointment, anger, or exhaustion after learning the cancer returned so soon is a normal reaction from someone who gave everything, not weakness.
You do not have to force positivity — acknowledging the feelings while asking for help lets you keep going longer.
- Ask for a distress thermometer check (0–10) — a score ≥4 is commonly where guidelines suggest referral to psycho-oncology or a psychologist
- Talk openly with the team about goals — what you want from treatment now and what matters most in daily life
- Bring someone close to appointments to take notes and ask questions when your mind goes blank
- Caregivers get tired too — share shifts and rest; see the caregiver guide for cancer spread to the lungs, liver, and bone (Thai)
- Insomnia or loss of interest in everything for more than 2 weeks, or thoughts of self-harm — tell the team or call a mental health crisis line immediately (Thailand: 1323)
Scientific mechanism (synthesized by the author)
Synthesized by
Asst. Prof. Dr. Norawit Raatpiboon:
Colorectal cancer cells reach the liver through the portal vein (blood from the bowel flows to the liver first) and reach the peritoneum by shedding from the tumor surface into the abdominal cavity,
then implanting on the peritoneal lining, ovaries, and mesentery — two different routes that respond differently to drugs.
Peritoneal and ovarian deposits have poor blood supply and dense fibrous stroma, so intravenous drugs penetrate poorly and these deposits shrink less readily than liver tumors.
Early relapse after oxaliplatin reflects selection of clones with enhanced DNA repair or drug efflux (clonal selection).
Switching to irinotecan — converted to SN-38, which inhibits topoisomerase I — attacks a different vulnerability,
while anti-VEGF agents reduce new tumor vessels and anti-EGFR antibodies work only when downstream RAS/BRAF signaling is normal.
The same drugs also affect liver cells — oxaliplatin damages sinusoidal endothelial cells (sinusoidal obstruction) and irinotecan promotes fat accumulation and inflammation (steatohepatitis).
Surgeons therefore weigh “enough tumor shrinkage” against “enough healthy liver remaining” — which is why conversion planning must be done as a team and with careful timing.
Frequently asked questions (FAQ)
Can colorectal cancer that has spread to both the liver and the peritoneum still be treated?
Yes. There are several lines of systemic therapy that can control the disease, extend life, and protect quality of life. The realistic main goal is disease control, while surgery or local treatment is reconsidered if the tumors respond well, by a multidisciplinary team that includes liver and peritoneal surgeons. Peritoneal disease makes complete removal less likely than liver-only spread, but it does not mean there are no options.
The surgeon said it is not resectable yet. Does that mean it can never be operated on?
Not necessarily. Not resectable yet usually means the tumors cannot be removed completely and safely right now, for example because there are many liver lesions or they sit next to major vessels, too little liver would remain, or the peritoneal disease is too widespread. The team gives systemic therapy first and re-images roughly every 2–3 months. If the tumors shrink and no new lesions appear, the case may go back to the multidisciplinary meeting to reassess surgery or local treatment, but no one can guarantee the outcome in advance.
What are the chances that conversion therapy makes surgery possible?
It depends heavily on the situation. The often-quoted response rate of about 60–70% comes from first-line treatment of liver-limited disease, such as the CELIM trial. In second-line treatment after early relapse, trials report overall response rates of roughly 5–35% depending on the regimen and biomarkers, and when peritoneal disease is also present the chance of surgery is lower still. The main goal is therefore disease control, with surgery reassessed if the tumors respond well.
I tolerated 15 cycles of chemo well. Will the new regimen work well too?
Good tolerance is a real advantage because it helps you receive treatment on schedule and at the planned dose, but it does not predict how strongly the tumors will respond to a new regimen. What tells you that is the CT or MRI after about 2–3 months of treatment, together with CEA and symptoms. Fifteen cycles of oxaliplatin may also leave numbness in the hands and feet, so tell the team, because it affects drug choice.
Why did the cancer come back only 3 months after stopping chemo?
Recurrence within about 6 months after oxaliplatin-containing treatment suggests that some cancer cells were resistant to that drug mechanism from the start or adapted during treatment, and it often reflects fairly aggressive biology. It does not mean the patient or the team did anything wrong. In practice the team usually switches to a backbone with a different mechanism, such as irinotecan (FOLFIRI) plus a biologic chosen by biomarkers, and often allows time to see the response before deciding on major surgery.
Is HIPEC needed?
Not for everyone. For colorectal cancer that has spread to the peritoneum, the randomized PRODIGE 7 trial found that adding oxaliplatin HIPEC after cytoreductive surgery (CRS) did not improve survival compared with CRS alone (median 41.7 vs 41.2 months) and caused more late complications. CRS itself may be considered for people with limited peritoneal disease, a low PCI score, and disease that can be removed completely, at an experienced centre. Ask the team whether your case meets these criteria.
Can I take herbs or supplements to support the liver?
Do not start them on your own. Herbs or extracts marketed as liver detox or liver support have no evidence that they control cancer or restore the liver during chemo, and some can harm the liver, such as high-dose green tea extract, or interact with drugs, such as St John’s wort lowering irinotecan levels. What helps the liver more is enough protein, clean cooked food, no alcohol, and telling the team about every herb, vitamin, and supplement.
How will we know if surgery has become possible?
The team looks at several things together: liver tumors shrinking with no new lesions on CT or MRI repeated roughly every 2–3 months, enough liver remaining after surgery (usually at least about 20–30% of the liver), peritoneal disease limited enough to be removed completely, which may need confirmation by diagnostic laparoscopy, a falling CEA trend, and adequate physical fitness. When these line up, the case is taken to the multidisciplinary meeting to plan together.
E-E-A-T and academic citations
Written by Asst. Prof. Dr. Norawit Raatpiboon (ผศ.ดร.นรวิชญ์ ราษฎร์พิบูลย์) — synthesized from ESMO / NCCN / ESPEN guidance and randomized trials on PubMed
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- NCCN Clinical Practice Guidelines — Colon Cancer
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- Verwaal VJ, et al. Cytoreduction and HIPEC vs systemic chemotherapy and palliative surgery. J Clin Oncol 2003 (PMID 14551293)
- Jacquet P, Sugarbaker PH. Diagnosis and staging of peritoneal carcinomatosis — Peritoneal Cancer Index. Cancer Treat Res 1996 (PMID 8849962)
- Franko J, et al. Prognosis of peritoneal metastatic colorectal cancer given systemic therapy (ARCAD). Lancet Oncol 2016 (PMID 27743922)
- Folprecht G, et al. Tumour response and secondary resectability with cetuximab (CELIM). Lancet Oncol 2010 (PMID 19942479)
- Bennouna J, et al. Continuation of bevacizumab after first progression (ML18147). Lancet Oncol 2013 (PMID 23168366)
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- Kopetz S, et al. Encorafenib, binimetinib, and cetuximab in BRAF V600E mCRC (BEACON). N Engl J Med 2019 (PMID 31566309)
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- Karoui M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006 (PMID 16371728)
- PubMed — Rubbia-Brandt L, et al. Sinusoidal obstruction with oxaliplatin-based chemotherapy. Ann Oncol 2004 (search)
- PubMed — Vauthey JN, et al. Chemotherapy regimen predicts steatohepatitis. J Clin Oncol 2006 (search)
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Medical Disclaimer
This content provides general education about metastatic colorectal cancer in the liver and peritoneum, second-line therapy, CRS ± HIPEC, and liver care during chemotherapy —
it is not a diagnosis, prescription, or guarantee that surgery or cure is possible. Trial figures describe selected patient groups.
Drug choice, biomarker testing, and surgery depend on assessment by your treating physician and multidisciplinary team, and coverage varies by health system.
In an emergency, go to the nearest emergency department or call your local emergency number (Thailand: 1669) immediately.