The CAIRO4 study, a randomized phase 3 trial conducted by the Dutch and Danish Colorectal Cancer Groups, examined the impact of upfront primary tumor resection (PTR) in patients with synchronous metastatic colorectal cancer (mCRC) without severe symptoms of the primary tumor. The study aimed to determine if adding upfront PTR to systemic therapy would provide a survival benefit.
A total of 206 patients were randomized to either upfront PTR followed by systemic therapy or systemic therapy alone. The primary endpoint was overall survival (OS). Results showed no significant difference in median OS between the two groups: 20.1 months for the upfront PTR arm versus 18.3 months for the non-PTR arm (p=0.32). Additionally, there were no significant differences in progression-free survival (PFS) or the incidence of grade 3-4 adverse events between the two groups.
These findings suggest that upfront PTR should not be routinely performed in patients with synchronous mCRC who do not have severe symptoms from their primary tumor. This practice does not confer a survival advantage and aligns with the results of other recent randomized trials.
For further details, access the full study at https://doi.org/10.1016/j.annonc.2024.06.001.
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