What is your approach to systemic therapy in newly diagnosed colon cancer with synchronous solitary liver metastases?

This is an important and challenging clinical question. In general, I favor a neoadjuvant chemotherapy treatment approach for a variety of reasons. For one, the EORTC trial provides us with supportive data that perioperative FOLFOX is associated with a modest improvement in outcome compared to surgery alone. Second, beginning with chemotherapy allows some time to observe the underlying biology of the disease before pursuing colon and liver resection. Patients with early progression clearly wouldn't have benefitted from initial surgery.

The relative tumor burden in liver and symptoms of the primary colon tumor also can influence my approach. For example, patients with multiple liver lesions, although technically resectable, should almost alw...