Target-based agents in neoadjuvant treatment of liver metastases from colorectal cancer: secret weapons in anti-cancer war?

The therapeutic options for liver metastases of colorectal
cancer mainly include surgical resection and palliative chemotherapy.
More recently, the increased availability of new and more
active cytotoxic drugs has increased the appeal of a combined
treatment strategy, in which chemotherapy is administered before
surgery. However, the efficacy of neoadjuvant chemotherapy of
CRC liver metastases is limited by: (1) the persistence of micro
metastatic foci that cannot be seen by conventional imaging
techniques, placed either in other sites throughout the liver
and/or in the site of the previous macroscopic metastasis that
has undergone to clinical complete response; (2) the occurrence
of escape mechanisms. The molecular basis regulating these
processes are described and the first clinical attempts to overcome
these mechanisms through the use of target-based agents are also
reported. Finally, biological rationales to optimize the activity of
these agents in neoadjuvant setting are discussed.