4.7 Review

Stage IV Colorectal Cancer Management and Treatment

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Molecular residual disease and efficacy of adjuvant chemotherapy in patients with colorectal cancer

Daisuke Kotani et al.

Summary: Circulating tumor DNA (ctDNA) analysis can help with risk stratification and treatment decisions for patients with resectable colorectal cancer (CRC). The study found that postsurgical ctDNA positivity was associated with higher recurrence risk and was the most significant prognostic factor for patients with stage II or III CRC. Furthermore, ctDNA positivity identified patients who derived benefit from adjuvant chemotherapy.

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Summary: Peritoneal metastasis is a malignant disease originating from gastrointestinal and gynecological carcinomas, causing long-term suffering in patients. New molecular mechanisms and treatments have been proposed, but more research is needed due to the uncertainty of influencing factors and the lack of a standardized procedure. We aim to summarize the backgrounds, mechanisms, and treatments in this area and identify limitations or new aspects for treatments.

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Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN

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Summary: Colorectal cancer is the third most common cancer worldwide, with the highest incidence rates in Australia/New Zealand and Europe, and the lowest rates in Africa and Southern Asia. The burden of colorectal cancer is projected to increase by 2040, with the majority of cases predicted to occur in high HDI countries.
Article Oncology

Treatment of Metastatic Colorectal Cancer: ASCO Guideline

Van K. Morris et al.

Summary: The purpose of this study is to develop treatment recommendations for patients with metastatic colorectal cancer (mCRC). An Expert Panel convened by ASCO conducted a systematic review of relevant studies and developed recommendations for clinical practice. Based on the inclusion criteria, five systematic reviews and ten randomized controlled trials were included in the analysis. The recommendations include offering doublet chemotherapy or triplet therapy to previously untreated mCRC patients who are initially unresectable, based on studies of chemotherapy combined with anti-vascular endothelial growth factor antibodies. Pembrolizumab is recommended for first-line treatment of mCRC patients with microsatellite instability-high or deficient mismatch repair tumors. Chemotherapy and anti-epidermal growth factor receptor therapy are recommended for microsatellite stable or proficient mismatch repair left-sided treatment-naive RAS wild-type mCRC, while chemotherapy and anti-vascular endothelial growth factor therapy are recommended for microsatellite stable or proficient mismatch repair RAS wild-type right-sided mCRC. Encorafenib plus cetuximab is recommended for previously treated BRAF V600E-mutant mCRC patients who have progressed after one previous line of therapy. Other recommendations are provided for patients with colorectal peritoneal metastases, liver metastases, and candidates for potentially curative resection of liver metastases. Multidisciplinary team management and shared decision making are also recommended.

JOURNAL OF CLINICAL ONCOLOGY (2023)

Review Oncology

Two stage hepatectomy (TSH) versus ALPPS for initially unresectable colorectal liver metastases: A systematic review and meta-analysis

Tamara Diaz Vico et al.

Summary: This systematic review and meta-analysis compared perioperative and oncological outcomes between Two Stage Hepatectomy (TSH) and Associating Liver Partition and Portal Vein Ligation for staged hepatectomy (ALPPS) in patients with initially unresectable colorectal liver metastases (CRLM). The results showed that ALPPS had higher postoperative major complications, higher completion of hepatectomy rates, and higher R0 resection rates compared to TSH. However, there were no significant differences in overall survival (OS) and disease-free survival (DFS) between the two groups.
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Cancer statistics, 2022

Rebecca L. Siegel et al.

Summary: Each year, the American Cancer Society compiles data on cancer occurrence and outcomes in the United States. The latest data shows that breast and prostate cancer progress has stagnated, while lung cancer has shown improvements in survival rates. Lung cancer incidence for advanced disease has declined while localized-stage rates have increased, resulting in higher survival rates. Mortality patterns align with incidence trends, with lung cancer deaths declining rapidly, breast cancer deaths slowing, and prostate cancer deaths stabilizing.

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Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy: a good alternative to total mesorectal excision surgery?

Petra A. Custers et al.

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First-Line Nivolumab Plus Low-Dose Ipilimumab for Microsatellite Instability-High/Mismatch Repair-Deficient Metastatic Colorectal Cancer: The Phase II CheckMate 142 Study

Heinz-Josef Lenz et al.

Summary: Nivolumab plus low-dose ipilimumab demonstrated robust and durable clinical benefit and was well tolerated as a first-line treatment for MSI-H/dMMR mCRC.

JOURNAL OF CLINICAL ONCOLOGY (2022)

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Surgical Therapy in Patients with Colorectal Liver Metastases

Jan Keck et al.

Summary: Surgical options for colorectal liver metastases (CRLM) are limited by the location of the metastases and their proximity to major vessels and intrahepatic bile ducts. Lesions in the periphery can be excised with a parenchymal-sparing fashion, while anatomical resections based on segmental boundaries are performed in other cases.

DIGESTION (2022)

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Panitumumab Plus Fluorouracil and Folinic Acid Versus Fluorouracil and Folinic Acid Alone as Maintenance Therapy in RAS Wild-Type Metastatic Colorectal Cancer: The Randomized PANAMA Trial (AIO KRK 0212)

Dominik Paul Modest et al.

Summary: The PANAMA trial investigated the efficacy of adding panitumumab to maintenance therapy in patients with RAS wild-type metastatic colorectal cancer, and found that combining panitumumab with fluorouracil and folinic acid could significantly improve progression-free survival in these patients.

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Eastern Cooperative Oncology Group Performance Status #434

Anne-Marie Mischel et al.

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Pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer (KEYNOTE-177): final analysis of a randomised, open-label, phase 3 study

Luis A. Diaz et al.

Summary: The final overall survival analysis of the KEYNOTE-177 study showed that while pembrolizumab continued to demonstrate durable antitumor activity and fewer treatment-related adverse events compared to chemotherapy in patients with microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer, there was no statistically significant difference in overall survival between the two treatment groups.

LANCET ONCOLOGY (2022)

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Effect of radical lymphadenectomy in colorectal cancer with para-aortic lymph node metastasis: a systematic review and meta-analysis

Pengyue Zhao et al.

Summary: This systematic review and meta-analysis found that radical lymphadenectomy can significantly improve overall survival in patients with colorectal cancer and para-aortic lymph node metastasis. It also showed that radical lymphadenectomy does not increase the risk of postoperative complications.

BMC SURGERY (2022)

Review Oncology

Efficacy and safety of different options for liver regeneration of future liver remnant in patients with liver malignancies: a systematic review and network meta-analysis

Fengming Yi et al.

Summary: This study compared the efficacy and safety of different surgical techniques for liver malignancies using network meta-analysis. The results showed that Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) had the highest increase in standardized future liver remnant (sFLR), shorter time to hepatectomy, and higher resection rate. However, ALPPS also had a higher complication rate and 90-day mortality compared to other treatments.

WORLD JOURNAL OF SURGICAL ONCOLOGY (2022)

Article Public, Environmental & Occupational Health

Role Of Ovarian Metastases In Colorectal Cancer (ROMIC): a Dutch study protocol to evaluate the effect of prophylactic salpingo-oophorectomy in postmenopausal women

R. Van der Meer et al.

Summary: The study aims to evaluate the effect of prophylactic salpingo-oophorectomy (PSO) in postmenopausal patients with colorectal cancer (CRC). Information bulletins and decision guides will be implemented in several Dutch hospitals to collect prospective data and estimate the incidence of ovarian metastases (OM) and primary ovarian cancer. The expected results will provide valuable information on the necessity of PSO in postmenopausal CRC patients.

BMC WOMENS HEALTH (2022)

Article Biochemistry & Molecular Biology

Survival Outcomes after Elective or Emergency Surgery for Synchronous Stage IV Colorectal Cancer

Ji-Yeon Mun et al.

Summary: Patients with stage IV colorectal cancer who have not undergone primary tumor resection are at risk of sudden medical emergencies. This study compared the survival outcomes of elective and emergency surgery in this population and found that elective surgery was associated with significantly better 2-year overall survival.

BIOMEDICINES (2022)

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Synchronous liver and peritoneal metastases from colorectal cancer: Is cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with liver resection a feasible option?

Sara Di Carlo et al.

Summary: This study reviewed the surgical and survival outcomes of an extensive surgical approach including cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) and liver resection (LR) for patients with colorectal liver and peritoneal metastases. The results showed higher morbidity and mortality rates in patients who underwent this extensive surgical approach compared to those who only underwent CRS and HIPEC. Additionally, the survival rates were worse for patients in the former group than the latter group. Therefore, a more accurate selection of patients and more restrictive surgical indications may improve outcomes in this subgroup of patients with limited curative options.

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Cost of treating metastatic colorectal cancer: a systematic review

N. Bhimani et al.

Summary: This systematic review examines the direct cost of treating metastatic colorectal cancer and highlights the significant economic burden it places on healthcare systems. The review emphasizes the need for future research to define cost components and examine the relationship between spending, overall survival, and quality of life.

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Treatment With Stereotactic Ablative Radiotherapy for Up to 5 Oligometastases in Patients With Cancer Primary Toxic Effect Results of the Nonrandomized Phase 2 SABR-5 Clinical Trial

Robert Olson et al.

Summary: This study confirms that the incidence of high-grade toxic effects in the large cohort of patients receiving SABR for oligometastases is less than 5%. The lower rates of toxic effects compared to previous studies may support further enrollment in randomized phase 3 clinical trials.

JAMA ONCOLOGY (2022)

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Incidence and Survival in Synchronous and Metachronous Liver Metastases From Colorectal Cancer

Noemi Reboux et al.

Summary: This study analyzed the temporal patterns and outcomes of synchronous and metachronous liver metastases from colorectal cancer using a population-based cohort study in France. The incidence of synchronous liver metastases remained relatively stable over time, while the probability of developing metachronous liver metastases decreased. Survival rates were significantly higher for patients with metachronous liver metastases compared to synchronous metastases. The differences in the epidemiological features of synchronous and metachronous liver metastases may have implications for future clinical trials.

JAMA NETWORK OPEN (2022)

Review Gastroenterology & Hepatology

Recent Advance in the Surgical Treatment of Metastatic Colorectal

Eun Jung Park et al.

Summary: Stage IV colorectal cancer (CRC) presents heterogeneous characteristics in tumor extent and biology, making treatment challenging. Tailored surgical treatments and multidisciplinary approaches may improve survival and the quality of life for patients with metastatic CRC.

JOURNAL OF THE ANUS RECTUM AND COLON (2022)

Review Medicine, Research & Experimental

Safety and long-term prognosis of simultaneous versus staged resection in synchronous colorectal cancer with liver metastasis: a systematic review and meta-analysis

Shi-hao Wang et al.

Summary: This meta-analysis compared the safety and prognosis of simultaneous and staged resection of synchronous colorectal liver metastases (SCLMs). The results showed that simultaneous resection had similar complications and survival outcomes compared to staged resection, but had lower intraoperative blood loss and shorter hospital stay. The study suggests that simultaneous resection can be considered as the first choice for resectable SCLM patients.

EUROPEAN JOURNAL OF MEDICAL RESEARCH (2022)

Article Oncology

Surgery combined with intra-operative microwaves ablation for the management of colorectal cancer liver metastasis: A case-matched analysis and evaluation of recurrences

Simone Guadagni et al.

Summary: Hepatic resection is the only chance of cure for a subgroup of patients with colorectal cancer liver metastasis. Intra-operative microwaves ablation combined with hepatic resection does not seem to have significant advantages over surgery alone in terms of oncologic outcomes for patients undergoing metastases resection with radical intent.

FRONTIERS IN ONCOLOGY (2022)

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An Evidence-Based Guideline for Surveillance of Patients after Curative Treatment for Colon and Rectal Cancer

Erin Kennedy et al.

Summary: Regular monitoring and surveillance are recommended for patients with Stage I-III colon cancer, including medical history, physical examination, and CT imaging. Current recommendations lack sufficient evidence to support similar surveillance regimens for patients with rectal cancer, Stage IV colon cancer, and elderly patients.

CURRENT ONCOLOGY (2022)

Article Surgery

Simultaneous Versus Delayed Resection for Initially Resectable Synchronous Colorectal Cancer Liver Metastases A Prospective, Open-label, Randomized, Controlled Trial

Karim Boudjema et al.

Summary: This study compared simultaneous resection and delayed resection of synchronous colorectal cancer liver metastases, finding no significant difference in the rate of major complications between the two groups. However, delayed resection tended to impair overall survival.

ANNALS OF SURGERY (2021)

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Survival outcome and prognostic factors for colorectal cancer with synchronous bone metastasis: a population-based study

Xiaofen Li et al.

Summary: The study investigated the survival outcomes and prognostic factors of patients with synchronous bone metastatic colorectal cancer, identifying seven independent prognostic factors including histological type, differentiation grade, T stage of primary tumor, CEA level, systemic chemotherapy, combined with liver metastasis and combined with lung metastasis. A novel nomogram based on these factors showed good performance in predicting survival outcomes in both internal and external validation.

CLINICAL & EXPERIMENTAL METASTASIS (2021)

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Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial

Francois Quenet et al.

Summary: This study aimed to evaluate the specific benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery compared with receiving cytoreductive surgery alone in patients with colorectal peritoneal metastases. The results showed no significant overall survival benefit after adding HIPEC, with more frequent postoperative late complications, suggesting that cytoreductive surgery alone should be prioritized as a treatment strategy.

LANCET ONCOLOGY (2021)

Article Oncology

Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Hyuna Sung et al.

Summary: The global cancer burden in 2020 saw an estimated 19.3 million new cancer cases and almost 10.0 million cancer deaths. Female breast cancer surpassed lung cancer as the most commonly diagnosed cancer, while lung cancer remained the leading cause of cancer death. These trends are expected to rise in 2040, with transitioning countries experiencing a larger increase compared to transitioned countries due to demographic changes and risk factors associated with globalization and a growing economy. Efforts to improve cancer prevention measures and provision of cancer care in transitioning countries will be crucial for global cancer control.

CA-A CANCER JOURNAL FOR CLINICIANS (2021)

Review Medicine, General & Internal

Diagnosis and Treatment of Metastatic Colorectal Cancer: A Review

Leah H. Biller et al.

Summary: Colorectal cancer is the third most common cause of cancer mortality worldwide. For patients diagnosed with metastatic colorectal cancer, approximately 70% to 75% can survive beyond 1 year. Tailoring treatments based on the molecular and pathologic features of the tumor has shown to improve overall survival rates.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

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Encorafenib Plus Cetuximab as a New Standard of Care for Previously Treated BRAF V600E-Mutant Metastatic Colorectal Cancer: Updated Survival Results and Subgroup Analyses from the BEACON Study

Josep Tabernero et al.

Summary: The study evaluated different treatment regimens for patients with BRAF V600E-mutant metastatic colorectal cancer, showing that encorafenib plus cetuximab improved overall survival, objective response rate, and progression-free survival compared to standard chemotherapy.

JOURNAL OF CLINICAL ONCOLOGY (2021)

Review Oncology

The Role of Cancer Stem Cells in Colorectal Cancer: From the Basics to Novel Clinical Trials

Celine Hervieu et al.

Summary: This review highlights the significance of colorectal cancer stem cells (CCSCs) in tumor growth, therapy resistance, and metastasis, while also discussing the methods for isolating and characterizing them, as well as ongoing clinical trials targeting CCSCs. The complexity of studying CSCs in CRC poses challenges in developing effective treatments that address therapy resistance and tumor initiation.

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Is There a Role for Perioperative Pelvic Radiotherapy in Surgically Resected Stage IV Rectal Cancer? A Propensity Score-matched Analysis

Jeanny Kwon et al.

Summary: This study showed that perioperative pelvic radiotherapy significantly improved overall survival rates in stage IV rectal cancer patients, especially in those without lung metastases. A web-based calculator was successfully developed to provide individualized estimates of survival benefit with the addition of radiotherapy for these patients.

AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS (2021)

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Current strategies to induce liver remnant hypertrophy before major liver resection

Celeste Del Basso et al.

Summary: Hepatic resection is the preferred treatment for liver tumors, but it carries the risk of post-operative liver failure. Clinical judgement is essential in selecting suitable patients for surgery and implementing effective pre-operative strategies to ensure an adequate future liver remnant.

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Metabolic Reprogramming of Colorectal Cancer Cells and the Microenvironment: Implication for Therapy

Miljana Nenkov et al.

Summary: Colorectal carcinoma is a common cancer characterized by metabolic reprogramming that provides tumor cells with energy and nutrients for malignant growth. The metabolic crosstalk between tumor cells, the tumor microenvironment, and gut microbiota facilitates the development and therapy resistance of colorectal carcinoma.

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES (2021)

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The clinicopathological characteristics, prognosis, and CT features of ovary metastasis from colorectal carcinoma

Zeyang Chen et al.

Summary: In this study, the clinical manifestations, pathological characteristics, and developments of patients with ovary metastasis from colorectal carcinoma (OM-CRC) were investigated through CT results. The research found that characteristics such as a well-defined ovarian mass, predominantly cystic, presence of peritoneal implantation, and absence of lymphadenopathy were common in OM-CRC cases. Additionally, synchronous metastasis and R2 resection during cytoreductive surgery were negatively associated with the prognosis of OM-CRC, with R2 resection being identified as the only independent predictor of overall survival and progression-free survival rates.

TRANSLATIONAL CANCER RESEARCH (2021)

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Strategies to tackle RAS-mutated metastatic colorectal cancer

G. Patelli et al.

Summary: RAS oncogene is commonly mutated in cancer, particularly in metastatic colorectal cancer (mCRC), leading to poor prognosis and resistance to certain treatments. Recent advancements in specific KRAS(G12C) inhibitors have renewed interest in targeting this biomarker. Direct KRAS(G12C) inhibition is emerging as a promising strategy in mCRC and other solid malignancies, showing potential for improved treatment efficacy in the future.

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Leilani Lakemeyer et al.

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