scholarly journals The role of chemotherapy in the management of resectable colorectal cancer

2003 ◽  
Vol 11 (3) ◽  
pp. 161-163
Author(s):  
Davorin Radosavljevic ◽  
Zorica Tomasevic ◽  
Ivan Popov ◽  
Svetislav Jelic
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Standard Of Care ◽  
New Drugs ◽  
Prognostic Indicators ◽  
Standard Regimen ◽  
Intraperitoneal Therapy ◽  
Accepted Standard ◽  
Portal Vein Infusion

Adjuvant chemotherapy has been established as the standard of care for patients with node-positive resected colon cancer. 5-fluorouracil modulated with leucovorin given for six months is currently the most widely accepted "standard" regimen. The role of adjuvant chemotherapy in stage II remain investigational and some prognostic indicators that correlate with higher risk for subsequent recurrence may be used for these patients when consider adjuvant chemotherapy. Other investigational approaches include regional portal vein infusion and intraperitoneal therapy, immunotherapy, and new drugs, with proven activity in metastatic disease. Patients older than 70 years are also candidate for adjuvant therapy of colorectal cancer. Adjuvant chemotherapy of rectal cancer is often associated with radiotherapy and enhances local control seen with radiotherapy and improves survival of these patients.

scholarly journals Update on the role of pembrolizumab in patients with unresectable or metastatic colorectal cancer

2021 ◽  
Vol 14 ◽  
pp. 175628482110244
Author(s):  
Vanessa Wookey ◽  
Axel Grothey
Keyword(s):  
Colorectal Cancer ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Standard Of Care ◽  
Cancer Type ◽  
Cancer Therapies ◽  
Multiple Cancer ◽  
Multiple Treatment

Colorectal cancer (CRC) is the third most common cancer type in both men and women in the USA. Most patients with CRC are diagnosed as local or regional disease. However, the survival rate for those diagnosed with metastatic disease remains disappointing, despite multiple treatment options. Cancer therapies for patients with unresectable or metastatic CRC are increasingly being driven by particular biomarkers. The development of various immune checkpoint inhibitors has revolutionized cancer therapy over the last decade by harnessing the immune system in the treatment of cancer, and the role of immunotherapy continues to expand and evolve. Pembrolizumab is an anti-programmed cell death protein 1 immune checkpoint inhibitor and has become an essential part of the standard of care in the treatment regimens for multiple cancer types. This paper reviews the increasing evidence supporting and defining the role of pembrolizumab in the treatment of patients with unresectable or metastatic CRC.

Treatment of Advanced Colorectal Cancer (CRC) in Daily Practice: Results of a Survey in two Italian Regions, Piemonte and Valle D'aosta

1998 ◽  
Vol 84 (5) ◽  
pp. 562-566 ◽  
Author(s):  
Alessandro Comandone ◽  
Roberto Berardo ◽  
Roberto Faggiuolo ◽  
Antonella Boglione ◽  
Paola Bergnolo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Performance Status ◽  
Daily Practice ◽  
New Drugs ◽  
Therapeutic Choice ◽  
Italian Regions ◽  
Important Health ◽  
Definition Of ◽  
No Gold Standard

Aims and background Colorectal cancer (CRC) is one of the most important health problems in Western countries: it is the fourth cancer in terms of incidence and the second cause of cancer death. Surgery is the main therapeutic choice and there is broad consensus on the role of adjuvant chemotherapy (CT) after resection. Unfortunately, 50% of the patients will relapse and die of the disease. Palliative CT based on 5-fluorouracil (5FU) may induce a 9-48% response rate with a median survival of 11.5 months. At present there is no gold standard for CT in advanced CRC and the situation has become more complicated since the advent of new drugs (Raltitrexed, Irinotecan, Oxaliplatin). The aim of this study was the identification of the different approaches to treatment of advanced CRC among the clinicians (oncologists, radiologists, internal medicine specialists, surgeons) who practice CT. Methods and study design Forty-six clinicians from two Italian Regions (Piemonte and Valle d'Aosta) were interviewed by telephone. Results 5FU modulated with Lederfolin according to the classic Machover scheme is the main option in daily practice. More sophisticated therapies are reserved to patients with a good performance status (PS) and are prescribed only in the larger centers. The planned therapies usually consist of six courses. Restaging may be performed after three or six courses. A marked difference has been recorded in the evaluation of a situation of no change (NC): 25.5% of the clinicians evaluate stable disease as a positive result. In the event of disease progression or relapse, 35% of the clinicians do not prescribe second-line CT. In case of further treatment, the options are totally subjective. Conclusions A national survey on this issue is necessary under the auspices of AIOM (Associazione Italiana Oncologia Medica) and involving oncologists, epidemiologists and statisticians, in order to define the reasons for variations in therapy in advanced CRC and determine the differences between clinicians of different age, specialization and location. This survey could lead to a definition of guidelines for the treatment of advanced CRC.

The role of adjuvant chemotherapy in stage II colorectal cancer patients

2014 ◽  
Vol 29 (10) ◽  
pp. 1237-1243 ◽  
Author(s):  
Hung-Hsin Lin ◽  
Yu-Yao Chang ◽  
Jen-Kou Lin ◽  
Jeng-Kai Jiang ◽  
Chun-Chi Lin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Stage Ii ◽  
Stage Ii Colorectal Cancer ◽  
Colorectal Cancer Patients

scholarly journals Prognostic role of tumor location in stage 3 colorectal cancer patients received adjuvant chemotherapy

2016 ◽  
Vol 27 ◽  
pp. vi200
Author(s):  
N. Ozdemir ◽  
S. Aslan ◽  
K. Erdogan ◽  
O. Yazici ◽  
M.A. Sendur ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Tumor Location ◽  
Prognostic Role ◽  
Colorectal Cancer Patients

Translating IDEA to Practice and Beyond: Managing Stage II and III Colon Cancer

2019 ◽  
pp. 226-235 ◽  
Author(s):  
Sharlene Gill ◽  
Jeffrey A. Meyerhardt ◽  
Monica Arun ◽  
Christine M. Veenstra
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Standard Of Care ◽  
Stage Ii ◽  
Stage Iii Colon Cancer ◽  
Optimal Duration ◽  
Accepted Standard ◽  
Early Stage Colon Cancer ◽  
Resected Stage

Adjuvant fluoropyrimidine-based chemotherapy has been the standard of care for resected stage III colon cancer since the 1990s; the evolution from 12 to 6 months of fluoropyrimidine therapy and the addition of oxaliplatin to fluoropyrimidine therapy have led to the current accepted standard. However, controversies remain. What is the benefit of adjuvant chemotherapy in stage II disease, and in whom? What is the optimal duration of adjuvant chemotherapy? How should patients with early-stage colon cancer be followed after surgery and adjuvant treatment? Recent evidence has emerged to help inform these important questions, including the International Duration Evaluation of Adjuvant therapy (IDEA) collaboration, which is the largest, prospective study in colon cancer with 12,834 patients. This review discusses current and future risk stratification strategies in stage II disease: the optimal duration of adjuvant oxaliplatin-containing chemotherapy in stage II and III disease according to the IDEA study, and the recent evidence and updated recommendations for surveillance of early-stage colon cancer after resection.

ATTACHE: A phase III, multicenter, randomized comparison of chemotherapy given prior to and post surgical resection versus chemotherapy given post surgical resection for hepatic metastases from colorectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS3643-TPS3643
Author(s):  
Jonathan Fawcett ◽  
Katrin Marie Sjoquist ◽  
Rob Padbury ◽  
Christopher Christophi ◽  
Niall Christopher Tebbutt ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Liver Metastases ◽  
Surgical Resection ◽  
Operative Treatment ◽  
Primary Tumour ◽  
Hepatic Metastases ◽  
Phase Iii ◽  
Treatment Needs

TPS3643 Background: No randomized studies have directly compared the role of peri-operative to adjuvant chemotherapy for resectable liver metastases. Benefit from post operative compared to peri-operative treatment has been suggested in a recent retrospective study of 499 patients with resected colorectal liver metastases which showed improved survival with entirely post-operative chemotherapy. Given this data and that of the small randomised trials demonstrating improved surgical outcomes with adjuvant chemotherapy, the role of entirely post-operative chemotherapy as a means of improving outcomes while reducing the negative effects of pre-operative treatment needs to be examined. Methods: 200 patients randomized 1:1 to 6 months of treatment post-operatively or 3 months of treatment pre-operatively and 3 months post-operatively. Site investigators will nominate chemotherapy schedule (mFOLFOX6, XELOX or FOLFIRI when adjuvant oxaliplatin received previously) prior to randomisation. Primary endpoint: proportion of patients in each arm with surgical complications within 30 days. Secondary endpoints: proportion of patients completing planned chemotherapy, post operative mortality rate (in each group), tolerability and safety of treatment, response rate by RECIST V1.1 and CEA, time to progression, time to treatment failure, overall survival, QoL (EORTC QLQ-C30 and QLQ-LMC21). A planned prospective meta-analysis with MRC (UK) and NSABP C-11 trials will have sufficient power to examine the effect of schedule (peri- or post-operative) on progression free survival (PFS). Eligibility: Patients with histologically proven colorectal cancer with radiologically confirmed, resectable liver metastases without evidence of extra-hepatic disease are eligible. Patients with synchronous metastases who have undergone resection of the primary tumour are eligible but patients requiring combined resection of primary cancer and liver metastatic disease are excluded. Patients with involved hilar nodes or wound implant metastases will not be eligible. Trial Status: Study opened to accrual August 2011.

scholarly journals The Role of BRAF in Metastatic Colorectal Carcinoma–Past, Present, and Future

2020 ◽  
Vol 21 (23) ◽  
pp. 9001 ◽  
Author(s):  
Angela Djanani ◽  
Silvia Eller ◽  
Dietmar Öfner ◽  
Jakob Troppmair ◽  
Manuel Maglione
Keyword(s):  
Colorectal Cancer ◽  
Standard Of Care ◽  
Mitogen Activated Protein Kinase ◽  
Clinical Aspects ◽  
New Era ◽  
Dismal Prognosis ◽  
Negative Prognostic Factor ◽  
Extracellular Signal ◽  
Mitogen Activated Protein

With a global incidence of 1.8 million cases, colorectal cancer represents one of the most common cancers worldwide. Despite impressive improvements in treatment efficacy through cytotoxic and biological agents, the cancer-related death burden of metastatic colorectal cancer (mCRC) is still high. mCRC is not a genetically homogenous disease and various mutations influence disease development. Up to 12% of mCRC patients harbor mutations of the signal transduction molecule BRAF, the most prominent being BRAFV600E. In mCRC, BRAFV600E mutation is a well-known negative prognostic factor, and is associated with a dismal prognosis. The currently approved treatments for BRAF-mutated mCRC patients are of little impact, and there is no treatment option superior to others. However, the gradual molecular understanding over the last decades of the extracellular signal-regulated kinase/mitogen-activated protein kinase pathway, resulted in the development of new therapeutic strategies targeting the involved molecules. Recently published and ongoing studies administering a combination of different inhibitors (e.g., BRAF, MEK, and EGFR) showed promising results and represent the new standard of care. In this review, we present, both, the molecular and clinical aspects of BRAF-mutated mCRC patients, and provide an update on the current and future treatment approaches that might direct the therapy of mCRC in a new era.

Better retrieval of lymph nodes in colorectal resection specimens by pathologists’ assistants

2012 ◽  
Vol 66 (1) ◽  
pp. 18-23 ◽  
Author(s):  
C C H J Kuijpers ◽  
H J van Slooten ◽  
W H Schreurs ◽  
G R H M Moormann ◽  
M A Abtahi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Patient Safety ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Colorectal Resection ◽  
Number Of Patients ◽  
Pathology Reports ◽  
Colorectal Cancer Patients

BackgroundErrors in surgical pathology are partly due to the increasing workload of pathologists. To reduce this workload, ‘pathologists’ assistants’ (PAs) have been trained to take over some of the pathologists’ recurrent tasks. One of these tasks is the precise examination of ≥10 lymph nodes (LNs), which is of paramount importance to reduce the risk of understaging of colorectal cancer patients.AimsTo evaluate the role of PAs in harvesting LNs in colorectal resection specimens and, by doing so, in improving patient safety.MethodsLN harvest was retrospectively reviewed in 557 pathology reports on colorectal resection specimens collected in two Dutch hospitals from 2008 until 2011.ResultsPAs sampled ≥10 LNs in significantly more cases than pathologists did (83.2% vs 60.9% in hospital A and 79.2% vs 67.6% in hospital B) and recovered on average significantly more LNs than pathologists did (18.5 vs 12.2 in hospital A and 16.6 vs 13.2 in hospital B). PAs harvested a significantly higher percentage of LNs <5 mm than pathologists did (64.2% vs 53.7%). The percentages of colon cancer patients eligible for adjuvant chemotherapy due to inadequate LN sampling alone were significantly higher for cases dissected by pathologists than for those dissected by PAs (17.3% vs 1.1% in hospital A and 13.1% vs 3.4% in hospital B)ConclusionsPAs contribute to patient safety since they recover more and, in particular, smaller LNs from colorectal resection specimens than pathologists do. Moreover, they help to reduce costs and morbidity by reducing the number of patients eligible for adjuvant chemotherapy due to inadequate LN sampling alone.

scholarly journals The role of the immunoescape in colorectal cancer liver metastasis

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259940
Author(s):  
Chie Takasu ◽  
Shoko Yamashita ◽  
Yuji Morine ◽  
Kozo Yoshikawa ◽  
Takuya Tokunaga ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastasis ◽  
Survival Rates ◽  
Hazard Ratio ◽  
Prognostic Indicators ◽  
Programmed Death ◽  
Immune Molecule ◽  
Programmed Death 1 ◽  
Positive Groups

The expression of programmed death 1 (PD-1) and programmed death-ligand 1 (PD-L1) indicate the efficacy of anti-PD-1/PD-L1 therapy in colorectal cancer (CRC), but are less useful for monitoring the efficacy of therapy of CRC liver metastasis (CRLM). This study investigated the effects of immune molecules on the prognosis of CRLM. We enrolled 71 patients with CRLM who underwent curative resection for CRC. We used immunohistochemistry to analyze the expression of PD-1, PD-L1, indoleamine-pyrrole 2,3-dioxygenase (IDO), and CD163 (a marker of tumor-associated macrophages [TAMs]) in metastatic tumors. The immune molecules PD-1, PD-L1, IDO, and TAMs were expressed in 32.3%, 47.8%, 45.0%, and 47.9% of metastatic CRC samples, respectively. The 5-year overall survival rates associated with immune molecule-positive groups were significantly better than in the negative groups (PD-1: 87.7% vs 53.2%, p = 0.023; PD-L1: 82.4% vs 42.3%, p = 0.007; IDO: 80.7% vs 43.5%, p = 0.007; TAMs: 82.6% vs 48.0%, p = 0.005). Multivariate analysis revealed PD-1 expression (p = 0.032, hazard ratio: 0.19), IDO expression (p = 0.049, hazard ratio: 0.37), and tumor differentiation (p<0.001, hazard ratio: 0.02) as independent prognostic indicators. PD-1 and TAMs in metastases were associated with less aggressive features such as smaller tumors. Furthermore, TAMs positively and significantly correlated with PD-1 expression (p = 0.011), PD-L1 expression (p = 0.024), and tended to correlate with IDO expression (p = 0.078). PD-1, PD-L1, IDO, and TAMs in CRLM were associated with less aggressive features and better prognosis of patients with CRC, indicating adaptive antitumor immunity vs immune tolerance. These molecules may therefore serve as prognostic markers for CRLM.

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