This study is a single-center, prospective, randomized, single-arm phase II clinical trial designed to evaluate the safety and efficacy of FULIRI chemotherapy regimen combined with targeted therapy (bevacizumab/cetuximab) as first-line conversion therapy for colorectal cancer with liver metastases. Eligible patients with colorectal cancer and liver metastases, after signing informed consent, received FULIRI chemotherapy combined with bevacizumab/cetuximab targeted therapy. Efficacy was assessed after every four treatment cycles, followed by multidisciplinary team (MDT) discussion regarding potential surgical resection, ablation, or stereotactic radiotherapy. The primary endpoint was the objective response rate (ORR), and secondary endpoints included: disease control rate (DCR), R0 resection rate of liver metastases, progression-free survival (PFS), 3-year/5-year survival rates, and the incidence of acute toxicities of any grade and grades 3/4.
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(1) Pathological diagnosis reveals the presence of neuroendocrine tumor, squamous cell carcinoma, or adenosquamous carcinoma components; (2) Presence of conditions requiring emergency treatment, such as bowel obstruction, bowel perforation, or bleeding; (3) Presence of multiple metastases in sites other than the liver (excluding localized lung metastases (≤2) or localized retroperitoneal lymph node metastases, provided the investigator assesses that the patient has a chance of achieving NED status); (4) Patients with known microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR) who are deemed suitable for immunotherapy with immune checkpoint inhibitors by the investigator; (5) Previous treatment with irinotecan; (6) Underweight (Body Mass Index [BMI] < 18 kg/m2); (7) Concurrent or previous history of other malignancies besides cervical carcinoma in situ and basal cell carcinoma of the skin; (8) Concurrent severe infection or active pulmonary tuberculosis; (9) History of immunodeficiency, including HIV positive, or other acquired or congenital immunodeficiency diseases, or history of organ transplantation; (10) Patients with hepatitis B, if hepatitis B DNA exceeds 1000 copies/mL, should be excluded; patients with hepatitis C, if hepatitis C RNA is positive, should be excluded; (11) Received surgery or other anti-tumor treatments (including chemotherapy, radiotherapy, investigational treatments, etc.) within 4 weeks prior to enrollment; (12) Concurrent severe gastrointestinal dysfunction (> Grade I according to NCI-CTCAE v5.0, such as intestinal inflammation or diarrhea); (13) Presence of conditions within the past 6 months that contraindicate targeted therapy, such as arterial embolism, severe bleeding, or bowel perforation (excluding bleeding caused by surgery); (14) Concurrent severe or uncontrolled systemic diseases, including but not limited to hypertension (systolic blood pressure consistently above 150 mmHg, diastolic blood pressure consistently above 95 mmHg), diabetes, heart disease, etc.; (15) Patients who cannot tolerate this study or who may be allergic to the medications used in this study; (16) Patients with cognitive impairment or co-existing severe mental disorders, who are judged by the investigator to have poor adherence to chemotherapy; or other situations deemed unsuitable for participation in clinical research by the investigator.
Single group
FULIRI combination targeted therapy
DrugChemotherapy regimen FULIRI: Irinotecan liposome 70 mg/m2; leucovorin CF 400 mg/m2, d1, iv drop; 5-FU 400 mg/m2, d1, iv drop; 5-FU 2400 mg/m2, d1, CIV 46-48h; repeated every 2 weeks. Combined targeted therapy: Based on tumor gene analysis results, investigators may choose to combine bevacizumab (5 mg/kg, iv drop, d1) or cetuximab (500 mg/m2, iv drop, d1), repeated every 2 weeks.
Objective Response Rate (ORR)
Objective response rate (ORR), also known as overall response rate or efficacy rate, refers to the proportion of patients in a clinical trial whose tumor volume shrinks to a predetermined value and remains at that level for a minimum specified duration.
Disease Control Rate (DCR)
DCR refers to the percentage of patients who achieve complete remission (CR), partial remission (PR), or stable disease (SD) after receiving a certain anti-tumor treatment, out of the total number of evaluable cases.
R0 resection rate of liver metastases
The proportion of surgical patients who achieve an R0 resection. R0 resection: All gross disease has been removed, and microscopic examination reveals all surgical margins free of tumor.
Progression-free survival (PFS)
PFS is defined as the time period from the start of treatment until disease progression or death.
Overall survival (OS)
The time interval between the date of randomization to the date of death. If the patient has been alive, the time until the last follow-up is taken as the overall survival period.
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