Challenge of Primary Tumor Management in Patients With Stage IV Colorectal Cancer

Optimal first-line therapy of patients who present with primary intact, unresectable stage IV colorectal cancer is controversial. Despite limited data, there are strong biases for either up-front primary tumor resection or for first-line systemic chemotherapy. The argument for up-front primary tumor resection is based on the desire to avoid potential complications of the intact primary tumor (IPT) such as bleeding, obstruction, or tumor perforation. Indeed the concern regarding the risk of primary tumor–related complications during systemic therapy, particularly with bevacizumab, has led both surgical and medical oncologists to advocate primary tumor resection at the time of diagnosis.^{1,2  Mehr}