Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

Cervantes, Andrés; Adam, R.; Roselló, Susana; Arnold, Dirk; Normanno, Nicola; Taı̈eb, Julien; Seligmann, Jenny F.; Baère, Thierry De; Österlund, Pia; Yoshino, Takayuki; Martinelli, Erika

doi:10.1016/j.annonc.2022.10.003

Cited by 584 publications

(612 citation statements)

References 163 publications

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“…Metastases are the main cause of CRC-related mortality [4]. Approximately 15-30% of patients present with metastases at the time of initial diagnosis [5]. Metastatic colorectal cancer (mCRC) has poor outcomes, with a relative five-year survival rate of 14% [4].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Type 2 Diabetes in Metastatic Colorectal Cancer

Baleiras¹,

Domingues²,

Severino³

et al. 2023

Cureus

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BackgroundDiabetes mellitus (DM) is a prognostic factor for some malignancies, but its clinical implications in metastatic colorectal cancer (mCRC) patients are less clear. Therefore, we conducted a retrospective study to evaluate the impact of pre-existing type 2 diabetes mellitus (T2DM) on the survival outcomes of patients with newly diagnosed mCRC. MethodologyWe retrospectively included patients with newly diagnosed mCRC between January 2017 and June 2021 and with pre-existing T2DM. Data on the characteristics of patients, clinicopathological features, and drug exposure were collected from the electronic medical records. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS) and treatment-related adverse events (TRAEs). ResultsAmong 187 mCRC patients, 54 (28.8%) had T2DM. The median follow-up was 25 months. We observed 150 OS events and 168 PFS events. Diabetes significantly and negatively impacted PFS and OS. The median for PFS (mPFS) was eight and 16 months for T2DM and no T2DM patients, respectively (p < 0.0001; log-rank test). The median overall survival (mOS) was 15 and 29 months for T2DM and no T2DM patients, respectively (p < 0.0001; log-rank test). Patients with diabetes were more often overweight or obese (59.3% vs. 24.8%; p < 0.01) and had a poorer performance status (53.7% vs. 21.1% with Eastern Cooperative Oncology Group Performance Status 1; p < 0.01). Additionally, T2DM patients had more high-risk pathological features, including G3 grading tumors (27.7% vs. 12.0%; p = 0.01), lymph node involvement (p < 0.01), BRAF-mutated (35.1% vs. 6.8%; p < 0.01), and right-sided CRC (63.0% vs. 30.1%; p < 0.01). We found no statistically significant differences in TRAEs. Nevertheless, a significantly higher rate of grade 2-4 peripheral neuropathy (22.2% vs. 5.3%; p < 0.01) was reported in T2DM patients. ConclusionsT2DM is a negative prognostic factor for survival in mCRC. The paper provides empirical evidence in favor of the joint control of both pathologies. Further research is needed to establish the robustness of our results.

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Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Type 2 Diabetes in Metastatic Colorectal Cancer

Baleiras¹,

Domingues²,

Severino³

et al. 2023

Cureus

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“…Microwave ablation (MWA) is an established tissue-sparing treatment for malignant liver tumours such as hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) [ 1 , 2 ]. In non-randomized studies, hepatic resection and MWA yield similar treatment efficacy and overall survival for CRLM [ 3 , 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two 2.45 GHz Microwave Ablation Devices with Respect to Ablation Zone Volume in Relation to Applied Energy in Patients with Malignant Liver Tumours

Ruiter

Jong

Pennings

et al. 2022

Cancers

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Purpose: (i) to compare two 2.45 GHz MWA devices with respect to AZV in relation to the applied energy after MWA in patients with hepatocellular carcinoma (HCC) or colorectal liver metastasis (CRLM) and (ii) to identify potential confounders for this relationship. Methods: In total, 102 tumours, 65 CRLM and 37 HCC were included in this retrospective analysis. Tumours were treated with Emprint (n = 71) or Neuwave (n = 31) MWA devices. Ablation treatment setting were recorded and applied energy was calculated. AZV and tumour volumes were segmented on the contrast-enhanced CT scans obtained 1 week after treatment. The AZV to applied energy R(AZV:E) ratios were calculated for each tumour treatment and compared between both MWA devices and tumour types. Results: R(AZV:E)EMPRINT was 0.41 and R(AZV:E)NEUWAVE was 0.81, p < 0.001. Moderate correlation between AZV and applied energy was found for Emprint (r = 0.57, R2 = 0.32, p < 0.001) and strong correlation was found for Neuwave (r = 0.78, R2 = 0.61, p < 0.001). R(AZV:E)CRLM was 0.45 and R(AZV:E)HCC was 0.52, p = 0.270. Conclusion: This study confirms the unpredictability of AZVs based on the applied output energy for HCC and CRLM. No significant differences in R(AZV:E) were observed between CRLM and HCC. Significantly lower R(AZV:E) was found for Emprint devices compared to Neuwave; however, reflected energy due to cable and antenna design remains unclear and might contribute to these differences.

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“… 1 Although recent advances in systemic therapy for metastatic CRC (mCRC) have improved outcomes for patients with certain biomarkers, most patients receive chemotherapy ± bevacizumab, and the 5-year survival rate is only 14.7%. 2 , 3 Programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) therapies have shown activity in patients with mismatch repair-deficient (dMMR) or microsatellite instability-high (MSI-H) CRC. 2 However, patients with mismatch repair-proficient (pMMR) or microsatellite stable (MSS) CRC (80%-90% of patients) do not respond to PD-1 blockade alone.…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 Programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) therapies have shown activity in patients with mismatch repair-deficient (dMMR) or microsatellite instability-high (MSI-H) CRC. 2 However, patients with mismatch repair-proficient (pMMR) or microsatellite stable (MSS) CRC (80%-90% of patients) do not respond to PD-1 blockade alone. 1 Limited activity may be due to mechanisms of resistance with PD-(L)1 and interplay with other pathways.…”

Section: Introductionmentioning

confidence: 99%

Bintrafusp Alfa: A Bifunctional Fusion Protein Targeting PD-L1 and TGF-β, in Patients with Pretreated Colorectal Cancer: Results from a Phase I Trial

Spira¹,

Wertheim

Kim

et al. 2022

The Oncologist

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Colorectal cancer (CRC) is a heterogeneous and complex disease with limited treatment options. Targeting transforming growth factor β (TGF-β) and programmed death ligand 1 pathways may enhance antitumor efficacy. Bintrafusp alfa is a first-in-class bifunctional fusion protein composed of the extracellular domain of TGF-β receptor II (a TGF-β “trap”) fused to a human IgG1 monoclonal antibody blocking programmed cell death ligand 1. We report results from an expansion cohort of a phase I study (NCT02517398) in patients with heavily pretreated advanced CRC treated with bintrafusp alfa. As of May 15, 2020, 32 patients with advanced CRC had received bintrafusp alfa for a median duration of 7.1 weeks. The objective response rate was 3.1% and the disease control rate was 6.3% (1 partial response, 1 stable disease); 2 patients were not evaluable. The safety profile was consistent with previously reported data.

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Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

Cited by 584 publications

References 163 publications

Prognostic Impact of Type 2 Diabetes in Metastatic Colorectal Cancer

Prognostic Impact of Type 2 Diabetes in Metastatic Colorectal Cancer

Comparison of Two 2.45 GHz Microwave Ablation Devices with Respect to Ablation Zone Volume in Relation to Applied Energy in Patients with Malignant Liver Tumours

Bintrafusp Alfa: A Bifunctional Fusion Protein Targeting PD-L1 and TGF-β, in Patients with Pretreated Colorectal Cancer: Results from a Phase I Trial

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