Prognostic and predictive response factors in colorectal cancer patients: Between hope and reality

Abstract

Colorectal cancer (CRC) represents one of the most commonly diagnosed cancers worldwide. It is the second leading cause of cancer death in Western Countries. In the last decade the survival of patients with metastatic CRC has improved dramatically. Due to the advent of new drugs (irinotecan and oxaliplatin) and target therapies (i.e., bevacizumab, cetuximab and panitumab), the median overall survival has risen from about 12 mo in the mid nineties to 30 mo recently. Many questions needing of right collocations and more clearness still exist regarding the prognostic factors and the predictive factors of response to therapy. Despite advances in dosing and scheduling of chemotherapy in both adjuvant and advanced settings, and a greater emphasis on early detection, the outlook still remains poor for most patients. Molecular analyses have shown that the natural history of all CRCs is not the same. Individual patients with same stage tumours may have different long term prognosis and response to therapy. In addition, some prognostic variables are likely to be more important than others. Here we review the role of prognostic factors and predictive factors according to the recently published English literature.

Analyses of Multiple Factors for Determination of "Selected Patients" Who Should Receive Rechallenge Treatment in Metastatic Colorectal Cancer: a Retrospective Study from Turkey

“…Thus, for the patients who have first-line PFS ≥12 months, rechallenge therapy option should be always kept in mind for the third and later-line treatments. ECOG PS, patients in clinical trials are also stratified according to several prognostic factors that are likely to have a significant role in influencing their survival (Divitiis et al, 2014). In our study, positive effect on OS of performance status is shown but positive effect on PFS is not shown.…”

“…In the studies, rechallange treatment was determined only for the patients who did not progressed at first evaluation (approximately 3 months before treatment) in first-line or second line therapy. There is no exact study which shows the interaction between the rechallange therapy of PFS & OS and PFS of the first line therapy in the literature (Divitiis et al, 2014). Studies are mostly focused on dividing the non-metastatic colon ca into two group such as; early recurrence group (within 1 year recurrence after surgical resection) and non-early recurrence group (without 1 year recurrence after surgical resection).…”

“…But there is no general consensus in considering parameters as valid and reliable prognostic factors, in patients with mCRC. The natural history of mCRC is not always the same; patients with mCRC may have various long term prognosis and respond differently to the same treatment (Divitiis et al, 2014). Here we have evaluated the role of prognostic factors in rechallenge treatment.…”

Circulating DNA as a Strong Multimarker Prognostic Tool for Metastatic Colorectal Cancer Patient Management Care

“…Metastatic colorectal cancer patients (mCRC) show a broad range of outcomes. No prognosis-validated biomarker is currently available for mCRC management (2). Several prognostic factors have been reported in the literature as predictors of mCRC patient survival: number of hepatic metastases, node-positive compared with node-negative primary, poorly differentiated compared with well or moderately primary, extra-hepatic disease compared with liveronly disease, tumor diameter, positive compared with negative resection margins, MSI versus MSS status and the carcinoembryonic antigen (CEA) level (3).…”

C35 is overexpressed in colorectal cancer and is associated tumor invasion and metastasis

“…In China, the incidence of CRC has been increasing in recent years as living conditions improve and eating habits change, with both sexes accounting for an estimated 253,000 patients in 2012 (1). Early detection and treatment of CRC is critical and is significantly associated with patient prognosis (2). Cancers that are confined within the wall of the colon may be cured with surgery while a tumor that has already spread is usually not curable and chemotherapy instead focuses on improving the patient's quality of life and symptoms (3)(4)(5).…”