Neoadjuvant chemotherapy combined with bevacizumab for resectable colorectal liver metastasis with risk factors for recurrence: a multicenter real-world study.

Background: Currently, guidelines prohibit the addition of targeted drugs in neoadjuvant chemotherapy (NAC) for initially resectable colorectal liver metastasis (CRLM).

Objective: Nevertheless, efficacy data of NAC combined with bevacizumab (Bev) for initially resectable CRLM with risk factors for recurrence (RFR) are lacking.

Designs: We conducted a multicenter real-world cohort study to retrospectively analyze the efficacy and feasibility of NAC combined with Bev for CRLM with RFR.

Methods: The patients were divided into the NAC alone group and NAC combined with the Bev group. We designated progression-free survival (PFS), objective response rate (ORR), and overall survival (OS) as the outcomes. Kaplan-Meier, Cox proportional hazards regression models, and subgroup analysis were utilized. RFR was a clinical risk score of 3-5. Subgroup analysis was applied to explore which subgroup was more suitable for NAC combined with Bev.

Results: Between 2015 and 2020, this multicenter real-world study encompassed 335 CRLM patients from six medical centers who underwent curative hepatectomy following NAC. Two hundred seventeen patients were in the NAC alone group, and 118 received NAC combined with Bev. The NAC alone group exhibited an ORR of 51.15%, compared to 66.95% in the NAC combined with Bev ( = 0.005). The R0 resection rates achieved 91.71% for the NAC alone group and 94.92% for the NAC combined with Bev ( = 0.276). Three-year PFS rate was 27.6% for NAC alone and 41.5% for the NAC combined with the Bev group ( = 0.006). Furthermore, the 3-year OS was calculated to be 57.0% for the NAC alone and 66.7% for the NAC combined with Bev patients ( = 0.079).

Conclusion: For initially resectable CRLM patients with RFR, NAC combined with Bev exhibited a higher ORR and longer PFS.

Chinese Clinical Trial Registry: ChiCTR2400082966.