Would you offer further chemotherapy in the adjuvant setting after resection of an isolated liver met that developed shortly after completion of adjuvant FOLFOX for colon cancer?

This is a difficult question but is a scenario we meet from time to time in the clinic.

The first question is when we say shortly after completion of adjuvant FOLFOX, what is the interval between completion of FOLFOX and the liver metastatic lesion detection? Usually, we think it is a short period of time if the metastatic disease was found within several months.

A common problem we see in the clinic is how certain we are that the liver lesion developed after the chemotherapy. There is a possibility that the lesion was there even during the adjuvant treatment and was missed in the previous image studies, or sometimes, the patient does not have any image study during the adjuvant treatment, then found a lesion shortly after completion of t...

I most likely will elect to observe this patient only.

Previously, the EORTC trial of peri-operative chemotherapy versus surgery alone, with up to four liver lesions, did not show a survival benefit with its updated publication in Lancet Oncology 2013.

Interesting data was presented in ASCO 2020 (#4005) from Japan. All patients had upfront liver resection then randomized to observation versus 12 cycles of mFOLFOX6. Median follow-up of 54 months showed survival is much, much better with surgery alone.

I doubt the benefits of additional chemotherapy after complete resection of the liver lesion(s) with the above data.

I agree with @Dr. First Last that ctDNA may help. However, we need to understand that ctDNA is not one test. Several companies c...