Impact of Metastasectomy in the Multimodality Approach for <i>BRAF</i> V600E Metastatic Colorectal Cancer: The Mayo Clinic Experience

Johnson, Benny; Jin, Zhaohui; Truty, Mark J.; Smoot, Rory L.; Nagorney, David M.; Kendrick, Michael L.; Kipp, Benjamin R.; Grothey, Axel

doi:10.1634/theoncologist.2017-0230

Cited by 35 publications

(25 citation statements)

References 32 publications

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“…In favor of metastasectomy of BRAF mutants were the findings of the only study to date that directly compared survival in patients who underwent resection of their BRAF tumors vs those who received systemic treatments only. Patients who underwent metastasectomy survived longer, although the difference was not as pronounced as we may have expected (29.1 vs 22.7 months) . Unfortunately, the two patient groups were not matched, and the authors did not report on the baseline characteristics of the two groups and some selection bias was inherent.…”

Section: Resultsmentioning

confidence: 80%

“…Lastly, Johnson et al from the Mayo Clinic was the only group that compared long‐term outcomes between surgically and medically treated patients with BRAF‐mutated tumors. They reported on a total of 52 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Patients who underwent metastasectomy survived longer, although the difference was not as pronounced as we may have expected (29.1 vs 22.7 months). 15 Unfortunately, the two patient groups were not matched, and the authors did not report on the baseline characteristics of the two groups and some selection bias was inherent. The favorable prognosis of BRAF mutants undergoing metastasectomy, despite the high recurrence rate and the short time to recurrence, may be attributed to recurrence patterns that either were amenable to a second metastasectomy or were associated with an intrinsically slower progression of recurrence.…”

mentioning

confidence: 99%

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Mutation status and surgical selection

Margonis

Kreis

Wolfgang

et al. 2019

Journal of Surgical Oncology

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Current evidence cannot support denying metastasectomy in otherwise resectable patients solely based on their overall KRAS or BRAF mutational status. The combination of KRAS or BRAF mutational status with certain clinicopathologic characteristics has defined groups of patients who may not derive benefit from metastasectomy, but external validation is needed. The effect of certain KRAS or BRAF variants on survival may be more pronounced and therefore future studies should consider them for surgical selection.

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Section: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Mutation status and surgical selection

Margonis

Kreis

Wolfgang

et al. 2019

Journal of Surgical Oncology

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“…Recently, a small single-center cohort study showed that 21 of 52 patients with BRAF V600E mutant who underwent metastasectomy had longer OS (29.1 vs. 22.7 months) and progression-free survival (13.6 vs. 6.2 months) than the non-metastasectomy cohort. The authors concluded that multimodality therapy incorporating metastasectomy for BRAF V600E metastatic CRC should be considered and might be associated with improved OS in selected patients [24]. Meanwhile, BRAF V600E can be a biomarker for selecting the appropriate chemotherapy regimen [21].…”

Section: Prognostic Determinantsmentioning

confidence: 99%

Colorectal Liver Metastases

Wiederkehr¹,

Wiederkehr²,

Wiederkehr³

2019

Surgical Challenges in the Management of Liver Disease

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The adenocarcinoma of the colon and rectum (CRC) affects more than 1.3 million patients each year, being the third most common malignancy in the world. Approximately, 30-50% of these patients will present with liver metastasis at the time of diagnosis or will develop metastasis later. The incidence of metastatic CRC (mCRC) is approximately 4.3% at 1 year, 8.7% at 2 years, 12% at 3 years, and 16.5% at 5 years after resection. Recently, the clinical outcome for patients with mCRC has improved, with a median overall survival (OS) for patients with mCRC is approximately 30 months, more than twice of that observed 20 years ago. The treatment approach for patients with colorectal liver metastases should be focused toward complete resection whenever possible, with both oncological and technical criteria being considered. Considering the fact that nearly 80% of patients with mCRC are not candidates for resection at diagnosis, initial treatment options include chemotherapy and locoregional therapies. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has emerged as modification on classic two-staged hepatectomy (TSH) with portal vein embolization. In experienced hepatobiliary centers and in well-selected patients, ALPPS can be performed with low morbidity and minimal mortality, resulting in good intermediate-term survival and excellent quality of life. Multidisciplinary tumor boards should critically scrutinize the best treatment options.

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“…Recently, a small single‐center cohort study showed that 21 of 52 patients with BRAF V600E mutant who underwent metastasectomy had longer OS (29.1 months vs 22.7 months) and PFS (13.6 months vs 6.2 months) compared with the non‐metastasectomy cohort. The authors concluded that multimodality therapy incorporating metastasectomy for BRAF V600E metastatic CRC (mCRC) should be considered and might be associated with improved OS in selected patients . Meanwhile, BRAF V600E can be a biomarker for selecting the appropriate chemotherapy regimen.…”

Section: Biomarkers For Crlmmentioning

confidence: 99%

Recent advances in treatment for colorectal liver metastasis

Oki

Ando

Nakanishi

et al. 2018

Annals of Gastroent Surgery

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A major challenge for the management of colorectal liver metastasis (CRLM) is the multidisciplinary approach including surgery. Resection is the most important treatment strategy to prolong the survival of patients with colorectal cancer (CRC). Even when resection is not possible as a primary treatment, it may still be carried out for curative intent after effective chemotherapy. Therefore, resection should always be considered when conducting chemotherapy for CRLM. Neoadjuvant anti‐epidermal growth factor receptor (EGFR) antibody has shown a high response rate for RAS wild CRC. However, whether anti‐EGFR antibody is superior to antivascular endothelial growth factor antibody for all types of CRLM is yet to be determined. Recently, several randomized control trials of first‐line therapy for advanced CRC have been conducted, and some of them are ongoing. The optimal chemotherapy regimen and tumor biology indicated for neoadjuvant chemotherapy as well as conversion surgery are expected to be determined in the near future.

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Impact of Metastasectomy in the Multimodality Approach for BRAF V600E Metastatic Colorectal Cancer: The Mayo Clinic Experience

Cited by 35 publications

References 32 publications

Mutation status and surgical selection

Mutation status and surgical selection

Colorectal Liver Metastases

Recent advances in treatment for colorectal liver metastasis

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