468PD - Evaluation for surgical treatment options in metastatic colorectal cancer (mCRC) – a retrospective, central evaluation of FIRE-3

Date 10 October 2016
Event ESMO 2016 Congress
Session Gastrointestinal tumours, colorectal
Topics Colon and Rectal Cancer
Surgical Oncology
Radiation Oncology
Presenter Ulf Neumann
Citation Annals of Oncology (2016) 27 (6): 149-206. 10.1093/annonc/mdw370
Authors U. Neumann1, T. Denecke2, J. Pratschke3, H. Lang4, M. Bemelmans5, T. Becker6, M. Rentsch7, D. Seehofer8, C.J. Bruns9, B. Gebauer2, G. Folprecht10, S. Stintzing11, S. Held12, V. Heinemann11, D.P. Modest11
  • 1Department Of General, Visceral And Transplantation Surgery, Universitaetsklinikum Aachen (UKA), 52074 - Aachen/DE
  • 2Institute Of Radiology, Charité, Campus Virchow Klinikum, Berlin/DE
  • 3General, Visceral, And Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin/DE
  • 44klinik Für Allgemein-, Viszeral- Und Transplantationschirurgie, Universitätsmedizin Mainz, Mainz/DE
  • 5Oncologiecentrum, Maastricht University Medical Center (MUMC), Maastricht/NL
  • 66klinik Für Allgemeine-, Viszeral-, Thorax-, Transplantations- Und Kinderchirurgie, UK-SH, Campus Kiel, Kiel/DE
  • 77department Of General, Visceral, Transplantation, Vascular And Thoracic Surgery, Klinikum der Universität München, München/DE
  • 88klinik Und Poliklinik Für Visceral-, Transplantations-, Thorax- Und Gefäßchirurgie, University of Leipzig, Leipzig/DE
  • 9Universitätsklinik Für Allgemein-, Viszeral- Und Gefäßchirurgie, Otto-von Guericke-Universität, Magdeburg/DE
  • 10Medical Department I, University Hospital Carl Gustav Technischen Univ.Dresden Medizinische, 01307 - Dresden/DE
  • 11Medical Dept. Iii, Klinikum der Universität München, München/DE
  • 12Clinassess Gmbh, ClinAssess GmbH, Leverkusen/DE



The integration of resections and/or ablation of metastases represent a cornerstone of multi-disciplinary treatment of mCRC, but access to this is often not fully evaluated.


We performed a central retrospective radiographic review of tumor lesions, conducted by eight visceral surgeons and three medical oncologists, with respect to surgical treatment options (with or without local thermic ablation, body radiation, etc), in addition to systemic treatment. Evaluation was done at baseline (before study treatment) and at “best response” (in 448 patients (pts.) receiving FOLFIRI plus cetuximab (arm A, 210 pts.) or FOLFIRI plus bevacizumab (arm B, 238 pts.). Investigators were blinded for treatment arm.


Based on a majority vote (≥50% votes for surgical-based intervention), resection of all tumor lesions at "baseline" (before treatment) was retrospectively considered possible in 97 (21.7%) pts. (23.3% arm A, 20.2% arm B), whereas at “best response” 238 (53.1%) pts. (53.3 % arm A, 52.9% arm B) were considered candidates for surgical resections (with or without additional locoregional therapy). These recommendations compare to reported secondary resection of tumor lesions in 60 (13.4%) pts. (13.8% arm A, 13.0% arm B). Additional 71 (15.8%) pts. (14.8% arm A, 16,8% arm B), of those 16 pts. in combination with operation, received locoregional therapies. The reviewers recommended surgery in 58 (96.7%) of effectively operated pts. and 48 (67.7%) of pts. with locoregional treatment. Additional information, including clinical (metastatic sites) and molecular subgroups as well as scoring of technical difficulties and expected clinical benefit of intended interventions, will be presented at the meeting.


In FIRE-3, surgery is a treatment option for approximately half of the pts. The discrepancy between possible and de facto done resections highlights the need for a multi-disciplinary decision making. The inclusion of dedicated surgeons or other interventionalists in addition to medical oncologists appears as mandatory, not only before start of treatment, but also more importantly during systemic treatment on a regular and preplanned basis.

Clinical trial identification


Legal entity responsible for the study

University of Munich


Merck, Pfizer


U. Neumann: Honoraria: Merck, Amgen, Roche Research Support: Merck. G. Folprecht: Honoraria - Merck, Roche/Genentech, Lilly, Bayer, Sanofi-Aventis, Baxalta, Servier, Boehringer. Study grant – Merck. S. Stintzing: Honoraria: Merck Serono, Roche/Genentech, Amgen, Bayer, sanofi-aventis Consulting or Advisory Role: Merck Serono, Roche Travel, Accommodations, Expenses: Roche/Genentech, Merck Serono, sanofi-aventis. V. Heinemann: Honoraria: Merck KGaA, Roche, Consulting or Advisory Role: Merck KGaA Speakers' Bureau: Merck KGaA Research Funding: Merck KGaA (Inst), Roche (Inst), Travel, Accommodations, Expenses: Merck KGaA, Roche. D.P. Modest: Merck: research support (inst), honoraria, travel Support, advisory boards Roche: research support (inst), honoraria. All other authors have declared no conflicts of interest.