Systemic Therapy for Colorectal Cancer Liver Metastases: Sorting Through the Options

Approximately one-quarter of patients with colorectal cancer have liver metastases (CLMs) at diagnosis. There is much debate regarding the optimal treatment of CLMs. Although many patients are diagnosed with CLMs initially (synchronous), many individuals develop hepatic metastases even after successful management of their primary tumor (metachronous). For this reason, much of our guidance for systemic and local therapies is centered on both preventing the development of liver metastases and eradicating existing CLMs. Surgical resection remains a mainstay of therapy; however, with the development of targeted biological agents and improvement of locoregional techniques for disease control including chemoembolization, thermal ablation, and arterial infusion chemotherapy, the management of CLMs is becoming more complex. This chapter focuses on the use of systemic chemotherapy and biologics in the management of CLMs.