Pre-operative Targeted Therapies in Patients with Hepatic Colorectal Cancer Metastases—Bevacizumab versus Cetuximab

Complete resection offers the greatest chance of cure for patients with isolated colorectal cancer liver metastases. While few patients present as candidates for curative surgery, induction chemotherapy may make patients with initially unresectable disease amenable to surgery. Even those whose disease is potentially curable at presentation may benefit from pre-operative neoadjuvant systemic therapy, particularly those deemed at high risk for relapse. Biological targeted therapies such as bevacizumab and cetuximab improve on standard systemic chemotherapeutic regimens in incurable patients; the rationale for their pre-operative use is also strong. Uncertainties remain as to which (if either) agent to preferentially use and their ultimate role in this setting must be better defined. This article reviews the concepts behind, and current data on, the use of pre-operative cetuximab and bevacizumab in patients with hepatic colorectal cancer metastases.