Summary
Metastatic colorectal cancer was long considered for palliative therapy, until significant improvement in surgical techniques and more effective chemotherapeutic regimens changed the way metastatic colon cancer patients are being treated today. Prospective trials were designed to answer the question which patient with metastatic disease could potentially be cured by a multidisciplinary approach with medical oncologists, surgeons and radiation oncology using an induction chemotherapy in combination with a targeted agent and being monitored for resectability in multidisciplinary tumor boards. Patients with oligometastatic disease should be treated with the goal of curative resection. This review will highlight studies conducted over the past 15 years addressing this issue. An algorithm is proposed illustrating how every newly diagnosed mCRC (metastatic colorectal cancer) patient could be discussed in the tumor board to decide the best treatment sequence with the best chance of cure.
Similar content being viewed by others
References
Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.
Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14:1208–15.
Gruenberger B, Tamandl D, Schueller J, et al. Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol. 2008;26:1830–5.
Hubert C, Sempoux C, Humblet Y, et al. Sinusoidal obstruction syndrome (SOS) related to chemotherapy for colorectal liver metastases: factors predictive of severe SOS lesions and protective effect of bevacizumab. HPB (Oxford). 2013;15:858–64.
Klinger M, Tamandl D, Eipeldauer S, et al. Bevacizumab improves pathological response of colorectal cancer liver metastases treated with XELOX/FOLFOX. Ann Surg Oncol. 2010;17:2059–65.
Viganò L, Capussotti L, De Rosa G, et al. Liver Resection for Colorectal Metastases after Chemotherapy: Impact of Chemotherapy-Related Liver Injuries, Pathological Tumor Response, and Micrometastases on Long-term Survival. Ann Surg. 2013;258:731–42.
Gruenberger T, Beets G, Van Laethem J‑L, et al. Treatment sequence of synchronously (liver) metastasized colon cancer. Dig Liver Dis. 2016;48:1119–23.
Nordlinger B, Van Cutsem E, Gruenberger T, et al. Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel. Ann Oncol. 2009;20:985–92.
Masi G, Vasile E, Loupakis F, et al. Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis. J Natl Cancer Inst. 2011;103:21–30.
Cremolini C, Loupakis F, Masi G, et al. FOLFOXIRI or FOLFOXIRI plus bevacizumab as first-line treatment of metastatic colorectal cancer: a propensity score-adjusted analysis from two randomized clinical trials. Ann Oncol. 2016;27:843–9.
Gruenberger T, Bridgewater J, Chau I, et al. Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015;26:702–8.
Folprecht G, Hamann S, Schütte K, et al. Dose escalating study of cetuximab and 5‑FU/folinic acid (FA)/oxaliplatin/irinotecan (FOLFOXIRI) in first line therapy of patients with metastatic colorectal cancer. BMC Cancer. 2014;14:521.
Cremolini C, Antoniotti C, Lonardi S, et al. Activity and safety of cetuximab plus modified folfoxiri followed by maintenance with cetuximab or bevacizumab for ras and braf wild-type metastatic colorectal cancer: A randomized phase 2 clinical trial. JAMA Oncol. 2018;4:529–36.
Fornaro L, Lonardi S, Masi G, et al. FOLFOXIRI in combination with panitumumab as first-line treatment in quadruple wild-type (KRAS, NRAS, HRAS, BRAF) metastatic colorectal cancer patients: a phase II trial by the Gruppo Oncologico Nord Ovest (GONO). Ann Oncol. 2013;24:2062–7.
Modest DP, Denecke T, Pratschke J, et al. Surgical treatment options following chemotherapy plus cetuximab or bevacizumab in metastatic colorectal cancer—central evaluation of FIRE-3. Eur J Cancer. 2018;88:77–86.
Andres A, Mentha G, Adam R, et al. Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases. Br J Surg. 2015;102:691–9.
Brouquet A, Vauthey JN, Contreras CM, et al. Improved survival after resection of liver and lung colorectal metastases compared with liver-only metastases: a study of 112 patients with limited lung metastatic disease. J Am Coll Surg. 2011;213:62–9.
Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg. 2006;243:1–7.
Ruers T, Van Coevorden F, Punt CJA, et al. Local treatment of unresectable colorectal liver metastases: results of a randomized phase II trial. J Natl Cancer Inst. 2017;109:djx15.
Wicherts DA, de Haas RJ, Salloum C, et al. Repeat hepatectomy for recurrent colorectal metastases. Br J Surg. 2013;100:808–18.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
T. Gruenberger, P. Jonas, R. Lutz, and B. Gruenberger declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Gruenberger, T., Jonas, P., Lutz, R. et al. Cure in metastatic disease: how to manage and who is the right patient in colorectal cancer?. memo 11, 317–321 (2018). https://doi.org/10.1007/s12254-018-0443-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12254-018-0443-8