***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Only a few papers have been published concerning the incidence and outcome of patients with a pathological complete response after cytotoxic treatment in breast cancer . The purpose of this retrospective study was to assess the outcome of patients found to have a pathological complete response in both the breast and axillary lymph nodes after neoadjuvant chemotherapy for operable breast cancer . Our goal was also to determine whether the residual pathological size of the tumour in breast could be correlated with pathological node status . Between 1982 and 2000 , 451 consecutive patients were registered into five prospect i ve phase II trials . After six cycles , 396 patients underwent surgery with axillary dissection for 277 patients ( 69.9 % ) .  Pathological response was evaluated according to the Chevallier 's classification . At a median follow-up of 8 years , survival was analysed as a function of pathological response . A pathological complete response rate was obtained in 60 patients ( 15.2 % ) after induction chemotherapy . Breast tumour persistence was significantly related to positive axillary nodes ( P=5.10−6 ) . At 15 years , overall survival and disease-free survival rates were significantly higher in the group who had a pathological complete response than in the group who had less than a pathological complete response ( P=0.047 and P=0.024 , respectively ) . In the absence of pathological complete response and furthermore when there is a notable remaining pathological disease , axillary dissection is still important to determine a major prognostic factor and subsequently , a second non cross resistant adjuvant regimen or high dose chemotherapy could lead to a survival benefit On June 20 , 2006 , the U.S. Food and Drug Administration ( FDA ) approved bevacizumab ( Avastin ; Genentech , Inc. , South San Francisco , CA ) , administered in combination with FOLFOX4 ( 5-fluorouracil , leucovorin , and oxaliplatin ) for the second-line treatment of metastatic carcinoma of the colon or rectum . Efficacy and safety were demonstrated in one Eastern Cooperative Oncology Group ( ECOG ) open-label , multicenter , r and omized , three-arm , active-controlled trial enrolling 829 adult patients . Patients had received a  fluoropyrimidine- and irinotecan-based regimen as initial therapy for metastatic disease ; or they had received prior adjuvant irinotecan-based chemotherapy and had recurred within 6 months of completing therapy . Treatments included bevacizumab , 10 mg/kg , as a 90-minute i.v . infusion on day 1 , every 2 weeks , either alone or in combination with FOLFOX4 , or FOLFOX4 alone . The bevacizumab monotherapy arm was closed to accrual after an interim efficacy analysis suggested a possibly shorter survival in that arm . Overall survival ( OS ) , the primary study endpoint , was significantly longer for patients receiving  bevacizumab in combination with FOLFOX4 than for those receiving FOLFOX4 alone . The objective response rate was significantly higher in the FOLFOX4 plus bevacizumab arm than in the FOLFOX4 alone arm . The duration of response was approximately 6 months for both treatment arms . Patients treated with the bevacizumab combination were also reported , based on investigator assessment , to have significantly longer progression-free survival . There were no new bevacizumab  safety signals . The most serious , and sometimes fatal , bevacizumab toxicities are gastrointestinal perforation , wound-healing complications , hemorrhage , arterial thromboembolic events , hypertensive crisis , nephrotic syndrome , and congestive heart failure PURPOSE The advantage of chemotherapy in asymptomatic patients with advanced colorectal cancer is debatable . Whether early chemotherapy improves survival and the length of the symptom-free period versus no therapy until symptoms appear was studied in a r and omized trial . PATIENTS AND METHODS A total of 183 patients with advanced , but asymptomatic colorectal cancer were r and omly allocated to receive either initial treatment with sequential methotrexate 250 mg/m2 during the first 2 hours , and fluorouracil ( 5-FU ) 500 mg/m2 at hours 3 and 23 followed by leucovorin rescue initiated at hour 24 ( MFL ) for 12 courses or to primary expectancy with chemotherapy not considered until symptoms appeared . One patient was ineligible and excluded from analysis . Nine patients did not fulfill the inclusion criteria and five patients refused treatment allocation ; these patients were not excluded from the study population so as not to introduce bias . So far , 51 of 90 ( 60 % ) patients in the expectancy group have received chemotherapy . RESULTS Overall survival was better in the MFL group than in the expectancy group ( Breslow-Gehan , P less than .02 ; log-rank , P = .13 ) with a difference in median survival of approximately 5 months . Also the symptom-free period and the time to disease progression were longer in the MFL group ( P less than .001 ) , with median differences of 8 and 4 months , respectively . Toxicity to MFL treatment was low ; however , three patients died because of toxicity -- none of them should have received therapy because of poor performance or S-creatinine elevation . The patients maintained an excellent performance throughout the MFL treatment unless the disease was progressive . CONCLUSION We concluded that early treatment with MFL in asymptomatic patients with advanced colorectal cancer prolongs survival , the asymptomatic period , and the time to disease progression by approximately 6 months over primary expectancy PURPOSE In this report , we up date survival ( OS ) and time-to-progression ( TTP ) data for the Intergroup trial N9741 after a median 5 years of follow-up by using risk-stratified and prognostic factor analyses to determine if treatment outcomes differ in specific patient subgroups . PATIENTS AND METHODS A total of 1,691 patients were r and omly assigned to one of seven fluorouracil- , oxaliplatin- , and irinotecan-containing regimens .  OS and TTP were calculated by treatment arm and baseline risk group ( on the basis of WBC , performance status , number of sites of disease , and alkaline phosphatase ) . Multivariate prognostic factor analysis was used to assess clinical factors for their relationships to OS , TTP , response , and toxicity by using Cox and logistic regression models . RESULTS The observed 5-year survival with infusional fluorouracil , leucovorin , and oxaliplatin ( FOLFOX ) of 9.8 % was better than with irinotecan plus bolus fluorouracil and leucovorin ( IFL ; 3.7 % ; P = .04 ) or with bolus irinotecan/oxaliplatin ( IROX ; 5.1 % ; P = .128 ) . OS and TTP were significantly longer for FOLFOX ( 20.2 months and 8.9 months , respectively ) than for IFL ( 14.6 months and 6.1 months , respectively ; P < .001 for both ) or for IROX ( 17.3 months and 6.7 months , respectively ; P < .001 for both ) . OS differed by risk group : 20.7 months for low risk , 17.4 months for intermediate risk , and 9.4 months for high risk ( P < .001 ) . FOLFOX treatment was superior in all risk groups and was the most powerful prognostic factor for OS , TTP , response rate , and toxicity . CONCLUSION The 9.8 % 5-year OS in patients with metastatic colorectal cancer who were treated with first-line FOLFOX sets a new benchmark . Neither baseline risk group nor any prognostic factor examined was predictive of treatment-specific outcome . However , treatment efficacy and patient longevity varied as a function of risk group 
    Output:
    
The CR is a rare event in advanced CRC ; however , the addition of MoAbs to first-line chemotherapy significantly increases the curative rate of metastatic disease compared with controls