Onkologie. 2020:14(3):126-130 | DOI: 10.36290/xon.2020.025

Current perspective on the treatment of advanced/metastatic colorectal cancer

Stanislav John
Klinika onkologie a radioterapie, FN Hradec Králové
Ústav lékařské biologie a genetiky, LF UK v Hradci Králové

Metastatic spread is responsible for the majority of all cancer deaths (1). The same, unfortunately, applies to colorectal cancer (CRC). However, multimodal combination therapy significantly improves the prognosis of patients, with some even being able to achieve long-term disease remission or even complete cure. More readily available and more accurate molecular analyses should be helpful in the effort to establish diagnosis, prognosis, and appropriate therapeutic objectives for a strictly individualized treatment. Novel treatment strategies emerge from clinical trials, but the rates of their implementation vary across countries. The present text aims at summarizing certain current recommendations while also providing some insight into the near, and hopefully more promising, future of the treatment of metastatic CRC (mCRC).

Keywords: colorectal cancer, targeted therapy.

Published: June 2, 2020  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
John S. Current perspective on the treatment of advanced/metastatic colorectal cancer. Onkologie. 2020;14(3):126-130. doi: 10.36290/xon.2020.025.
Download citation

References

  1. DillekÅs H, Rogers MS, Straume O. Are 90 % of deaths from cancer caused by metastases? Cancer medicine, 2019; 8(12): 5574-5576. Go to original source... Go to PubMed...
  2. López-Lázaro M. Why do tumors metastasize? Cancer Biology & Therapy 2007; 6(2): 141-144. Go to original source... Go to PubMed...
  3. Zhang M, Liu T, Sun H, Weng W, et al. Pim1 supports human colorectal cancer growth during glucose deprivation by enhancing the Warburg effect. Cancer Sci May 2018; 109(5): 1468-1479. Go to original source... Go to PubMed...
  4. Xu R, Rai A, Chen M, Suwakulsiri W, et al. Extracellular vesicles in cancer - implications for future improvements in cancer care. Nat Rev Clin Oncol Oct 2018; 15(10): 617-638. Go to original source... Go to PubMed...
  5. Kim TM, Jung SH, An CH, Lee SH, et al. Subclonal Genomic Architectures of Primary and Metastatic Colorectal Cancer Based on Intratumoral Genetic Heterogeneity. Clin Cancer Res Oct 1 2015; 21(19): 4461-4472. Go to original source... Go to PubMed...
  6. Wei Q, Ye Z, Zhong X, Li L, et al. Multiregion whole-exome sequencing of matched primary and metastatic tumors revealed genomic heterogeneity and suggested polyclonal seeding in colorectal cancer metastasis. Ann Oncol Sep 1 2017; 28(9): 2135-2141. Go to original source... Go to PubMed...
  7. Guinney J, Dienstmann R, Wang X, De Reynies A, et al. The consensus molecular subtypes of colorectal cancer. Nat Med. Nov 2015; 21(11): 1350-1356. Go to original source... Go to PubMed...
  8. Hashiguchi Y, Muro K, Saito Y, Ito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. Jan 2020; 25(1): 1-42. Go to original source...
  9. Tsikitis VL, Larson DW, Huebner M, Lohse CM, et al. Predictors of recurrence free survival for patients with stage II and III colon cancer. BMC Cancer. May 16 2014; 14: 336. Go to original source... Go to PubMed...
  10. Huang CW, Tsai HL, Chen YT, Huang CM, et al. The prognostic values of EGFR expression and KRAS mutation in patients with synchronous or metachronous metastatic colorectal cancer. BMC Cancer 2013; 13: 599. Go to original source... Go to PubMed...
  11. Timar J, Piurko V, Kenessey I, Raso E, et al. EGFR protein expression of the metastatic colorectal cancer as a prognostic/predictive factor for anti-EGFR antibody therapy. Journal of Clinical Oncology 2018; 36(15_suppl): e15548-e15548. Go to original source...
  12. Zhao B, Wang L, Qiu L, Zhang M, et al. Mechanisms of resistance to anti-EGFR therapy in colorectal cancer. Oncotarget Jan 17 2017; 8(3): 3980-4000. Go to original source... Go to PubMed...
  13. Arrington AK, Heinrich EL, Lee W, Duldulao M, et al. Prognostic and predictive roles of KRAS mutation in colorectal cancer. Int J Mol Sci, Sep 25 2012; 13(10): 12153-12168. Go to original source... Go to PubMed...
  14. De Roock W, Claes B, Bernasconi D,De Schutter J, et al. Effects of KRAS, BRAF, NRAS, and PIK3CA mutations on the efficacy of cetuximab plus chemotherapy in chemotherapy-refractory metastatic colorectal cancer: a retrospective consortium analysis. Lancet Oncol Aug 2010; 11(8): 753-762. Go to original source...
  15. Irahara N, Baba Y, Nosho K, Shima K, et al. NRAS mutations are rare in colorectal cancer. Diagn Mol Pathol, Sep 2010; 19(3): 157-163. Go to original source...
  16. Therkildsen C, Bergmann TK, Henrichsen-Schnack T, Ladelund S, et al. The predictive value of KRAS, NRAS, BRAF, PIK3CA and PTEN for anti-EGFR treatment in metastatic colorectal cancer: A systematic review and meta-analysis. Acta Oncol, Jul 2014; 53(7): 852-864. Go to original source...
  17. Liu P, Wang Y, Li X. Targeting the untargetable KRAS in cancer therapy. Acta Pharm Sin B, Sep 2019; 9(5): 871-879. Go to original source... Go to PubMed...
  18. Nagasaka M, Li Y, Sukari A, Ou SI, et al. KRAS G12C Game of Thrones, which direct KRAS inhibitor will claim the iron throne? Cancer Treat Rev. Jan 23 2020; 84: 101974. Go to original source...
  19. Wan P T, Garnett MJ, Roe SM,Lee S, et al. Mechanism of activation of the RAF-ERK signaling pathway by oncogenic mutations of B-RAF. Cell, Mar 19 2004; 116(6): 855-867. Go to original source... Go to PubMed...
  20. Sanz-Garcia E, Argiles G, Elez E, Tabernero J. BRAF mutant colorectal cancer: prognosis, treatment, and new perspectives. Ann Oncol. Nov 1 2017; 28(11): 2648-2657. Go to original source... Go to PubMed...
  21. Midthun L, Shaheen S, Deisch J, Senthil M, et al. Concomitant KRAS and BRAF mutations in colorectal cancer. J Gastrointest Oncol. Jun 2019; 10(3): 577-581. Go to original source... Go to PubMed...
  22. Sahin IH, Kazmi SM, Yorio JT, Bhadkamkar NA, et al. Rare Though Not Mutually Exclusive: A Report of Three Cases of Concomitant KRAS and BRAF Mutation and a Review of the Literature. J Cancer 2013; 4(4): 320-322. Go to original source... Go to PubMed...
  23. Lynch HT, Shaw TG. Practical genetics of colorectal cancer. Chin Clin Oncol. Jun 2013; 2(2): 12.
  24. Ligtenberg MJL, Kuiper RP, Chan TL, Goossens M, et al. Heritable somatic methylation and inactivation of MSH2 in families with Lynch syndrome due to deletion of the 3´ exons of TACSTD1. Nature Genetics 2009; 41(1): 112-117. Go to original source... Go to PubMed...
  25. Martin-Lopez JV, Fishel R. The mechanism of mismatch repair and the functional analysis of mismatch repair defects in Lynch syndrome. Fam Cancer. Jun 2013; 12(2): 159-168. Go to original source... Go to PubMed...
  26. Svrcek M, Lascols O, Cohen R, Collura A, et al. MSI/MMR-deficient tumor diagnosis: Which standard for screening and for diagnosis? Diagnostic modalities for the colon and other sites: Differences between tumors. Bull Cancer, Feb 2019; 106(2): 119-128. Go to original source...
  27. Parsons MT, Buchanan DD, Thompson B, Young JP, et al. Correlation of tumour BRAF mutations and MLH1 methylation with germline mismatch repair (MMR) gene mutation status: a literature review assessing utility of tumour features for MMR variant classification. J Med Genet, Mar 2012; 49(3): 151-157. Go to original source...
  28. Tejpar S, Saridaki Z, Delorenzi M, Bosman F, et al. Microsatellite instability, prognosis and drug sensitivity of stage II and III colorectal cancer: more complexity to the puzzle. J Natl Cancer Inst, Jun 8 2011; 103(11): 841-844. Go to original source... Go to PubMed...
  29. Battaglin F, Naseem M, Lenz HJ, Salem ME. Microsatellite instability in colorectal cancer: overview of its clinical significance and novel perspectives. Clin Adv Hematol Oncol, Nov 2018; 16(11): 735-745.
  30. Helsten T, Elkin S, Arthur E, Tomson BN, et al. The FGFR Landscape in Cancer: Analysis of 4,853 Tumors by Next-Generation Sequencing. Clin Cancer Res, Jan 1 2016; 22(1): 259-267. Go to original source... Go to PubMed...
  31. Ingold Heppner B, Behrens HM, Balschun K, Haag J, et al. HER2/neu testing in primary colorectal carcinoma. British Journal of Cancer 2014; 111(10): 1977-1984. Go to original source... Go to PubMed...
  32. Solomon JP, Benayed R, Hechtman JF, Ladanyi M. Identifying patients with <em>NTRK</em> fusion cancer. Annals of Oncology, 2019; 30: viii16-viii22. Go to original source...
  33. Wang XY, Zheng ZX, Sun Y, Bai YH, et al. Significance of HER2 protein expression and HER2 gene amplification in colorectal adenocarcinomas. World J Gastrointest Oncol, Apr 15 2019; 11(4): 335-347. Go to original source... Go to PubMed...
  34. Tournigand C, Andre T, Achille E, Lledo G, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol, Jan 15 2004; 22(2): 229-237. Go to original source... Go to PubMed...
  35. Modest DP, Martens UM, Riera-Knorrenschild J, Greeve J, et al. FOLFOXIRI Plus Panitumumab As First-Line Treatment of RAS Wild-Type Metastatic Colorectal Cancer: The Randomized, Open-Label, Phase II VOLFI Study (AIO KRK0109). Journal of Clinical Oncology, 2019; 37(35): 3401-3411. Go to original source... Go to PubMed...
  36. Shui L, Wu YS, Lin H, Shui P, et al. Triplet Chemotherapy (FOLFOXIRI) Plus Bevacizumab Versus Doublet Chemotherapy (FOLFOX/FOLFIRI) Plus Bevacizumab in Conversion Therapy for Metastatic Colorectal Cancer: a Meta-Analysis. Cell Physiol Biochem, 2018; 48(5): 1870-1881. Go to original source...
  37. Cremolini C, Marmorino F, Loupakis F, Masi G, et al. TRIBE-2: a phase III, randomized, open-label, strategy trial in unresectable metastatic colorectal cancer patients by the GONO group. BMC Cancer, Jun 9 2017; 17(1): 408. Go to original source... Go to PubMed...
  38. Gomez A, Vieitez JM, Gil S, Salvia AS, et al. Safety analysis of a phase III randomized trial comparing FOLFOX + Bevacizumab vs FOLFOXIRI + Bevacizumab as 1st line treatment in patients with metastatic colorectal cancer (mCRC) with ≥3 circulating tumor cells (CTCs) (VISNÚ-1 TTD TRIAL). Journal of Clinical Oncology, 2018; 36(15_suppl): 3536-3536. Go to original source...
  39. Chan DLH, Segelov E, Wong RS, Smith A, et al. Epidermal growth factor receptor (EGFR) inhibitors for metastatic colorectal cancer. The Cochrane database of systematic reviews, 2017; 6(6): CD007047-CD007047. Go to original source...
  40. Cremolini C, Antoniotti C, Lonardi S, Bergamo F, et al. Primary tumor sidedness and benefit from FOLFOXIRI plus bevacizumab as initial therapy for metastatic colorectal cancer. Retrospective analysis of the TRIBE trial by GONO. Ann Oncol. Jul 2018; 29(7): 1528-1534. Go to original source...
  41. Holch JW, Ricard I, Stintzing S, Modest DP, et al. The relevance of primary tumour location in patients with metastatic colorectal cancer: A meta-analysis of first-line clinical trials. Eur J Cancer, Jan 2017; 70: 87-98 Go to original source... Go to PubMed...
  42. ArnoldD, Lueza B, Douillard JY, Peeters M. et al. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol, Aug 1 2017; 28(8): 1713-1729. Go to original source... Go to PubMed...
  43. Messersmith WA. NCCN Guidelines Updates: Management of Metastatic Colorectal Cancer. J Natl Compr Canc Netw, May 1 2019; 17(5.5): 599-601. Go to PubMed...
  44. Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, et al. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol, Jan 1 2018; 29(1): 44-70. Go to original source... Go to PubMed...
  45. Triest L., Debeuckelaere C, Vandamme T, Van Den Heuvel B, et al. Should Anti-EGFR Agents Be Used in Right-Sided RAS Wild-type Advanced Colorectal Cancer? Current Colorectal Cancer Reports, 2019; 15(4): 130-134. Go to original source...
  46. Fornaro L, Vasile E, Masi G, Loupakis F, et al. Outcome of second-line treatment after first-line chemotherapy with the GONO FOLFOXIRI regimen. Clin Colorectal Cancer, Mar 2012; 11(1): 71-76. Go to original source... Go to PubMed...
  47. Ciardiello F, Normanno N, Martinelli E, Troiani T, et al. Cetuximab continuation after first progression in metastatic colorectal cancer (CAPRI-GOIM): a randomized phase II trial of FOLFOX plus cetuximab versus FOLFOX. Annals of Oncology, 2016; 27(6): 1055-1061. Go to original source... Go to PubMed...
  48. Kiss I, Mlcochova J, Bortlicek Z, Poprach A, et al. Efficacy and Toxicity of Panitumumab After Progression on Cetuximab and Predictive Value of MiR-31-5p in Metastatic Wild-type KRAS Colorectal Cancer Patients. Anticancer Res, Sep 2016; 36(9): 4955-4959. Go to original source...
  49. Bennouna J, Sastre J, Arnold D, Osterlund P, et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol, Jan 2013; 14(1): 29-37. Go to original source...
  50. Wirapati P, Pomella V, Vandenbosch B, Kerr P, et al. VELOUR trial biomarkers update: Impact of RAS, BRAF, and sidedness on aflibercept activity. Annals of Oncology, 2017; 28: iii151-iii152. Go to original source...
  51. Modest, DP, Stintzing S, Von Weikersthal LF, Decker T, et al. Exploring the effect of primary tumor sidedness on therapeutic efficacy across treatment lines in patients with metastatic colorectal cancer: analysis of FIRE-3 (AIOKRK0306). Oncotarget 2017; 8(62): 105749-105760. Go to original source... Go to PubMed...
  52. Grothey A, Van Cutsem E, Sobrero E, Siena S, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet, Jan 26 2013; 381(9863): 303-312. Go to original source...
  53. Van Cutsem E, Mayer RJ, Laurent S, Winkler R, et al. The subgroups of the phase III RECOURSE trial of trifluridine/tipiracil (TAS-102) versus placebo with best supportive care in patients with metastatic colorectal cancer. Eur J Cancer; Feb 2018, (90): 63-72. Go to original source... Go to PubMed...
  54. Tanaka A, Sadahiro S, Suzuki T, Okada K, et al. Retrospective study of regorafenib and trifluridine/tipiracil efficacy as a third-line or later chemotherapy regimen for refractory metastatic colorectal cancer. Oncology letters, 2018; 16(5): 6589-6597. Go to original source... Go to PubMed...
  55. Moehler MH, Stein A, Trojan J, Marquardt JU, et al. Regorafenib with TAS-102 (REGOTAS) in metastatic colorectal cancer patients who progressed after at least two standard therapies: Efficacy and safety results of a multicenter phase I study (REMETY). Journal of Clinical Oncology 2020; 38(4_suppl): 158-158. Go to original source...
  56. Arnold D, Prager GW, Qiuntela A, Stein A, et al. Beyond second-line therapy in patients with metastatic colorectal cancer: a systematic review. Ann Oncol, Apr 1 2018; 29(4): 835-856. Go to original source... Go to PubMed...
  57. Nakamura M. MO3-12-5 - Phase II Study of Cetuximab Rechallenge in Patients with RAS Wild-Type metastatic Colorectal Cancer: E-Rechallenge Trial. Annals of Oncology 2019; 30: vi116. Go to original source...
  58. Rossini D, Cremolini C, Re MD, Lonardi S, et al. Abstract CT088: Efficacy of anti-EGFR rechallenge in <em>RAS</em> and <em>BRAF</em> wt metastatic colorectal cancer: Clinical and translational results of the phase II CRICKET study by GONO. Cancer Research 2018; 78(13 Supplement): CT088-CT088. Go to original source...
  59. Mauri G, Pizzutilo EG, Amatu A, Bencardino K, et al. Retreatment with anti-EGFR monoclonal antibodies in metastatic colorectal cancer: Systematic review of different strategies. Cancer Treat Rev, Feb 2019; 73: 41-53. Go to original source...
  60. Corcoran RB, Andre T, Atreya CE, Schellens JHM, et al. Combined BRAF, EGFR, and MEK Inhibition in Patients with BRAF(V600E)-Mutant Colorectal Cancer. Cancer discovery, Apr 2018; 8(4): 428-443. Go to original source... Go to PubMed...
  61. Kopetz S, Grothey A, Van Cutsem E, Yaeger R, et al. BEACON CRC: a randomized, 3-Arm, phase 3 study of encorafenib and cetuximab with or without binimetinib vs. choice of either irinotecan or FOLFIRI plus cetuximab in BRAF V600E-mutant metastatic colorectal cancer. Ann Oncol; Jul 2019: 30 Suppl 4, iv154. Go to original source...
  62. Franke AJ, Skelton WP, Starr JS, Parekh H, et al. Immunotherapy for Colorectal Cancer: A Review of Current and Novel Therapeutic Approaches. J Natl Cancer Inst, Nov 1 2019; 111(11): 1131-1141. Go to original source...
  63. Galon J, Lanzi A. Immunoscore and its introduction in clinical practice. Q J Nucl Med Mol Imaging; Feb 27 2020. Go to original source...
  64. Le DT, Durham JN, Smith KN, Wang H, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science, Jul 28 2017; 357(6349): 409-413. Go to original source...
  65. Le DT, Uram JN, Wang H, Bartlett BR, et al. PD-1 Blockade in Tumors with Mismatch-Repair Deficiency. N Engl J Med, Jun 25 2015; 372(26): 2509-2520. Go to original source...
  66. Le DT, Kim TW, Van Cutsem E, Geva R, et al. Phase II Open-Label Study of Pembrolizumab in Treatment-Refractory, Microsatellite Instability-High/Mismatch Repair-Deficient Metastatic Colorectal Cancer: KEYNOTE-164. J Clin Oncol. Jan 1 2020; 38(1): 11-19. Go to original source... Go to PubMed...
  67. Overman MJ, Lonardi S, Wong KYM, Lenz HJ, et al. Durable Clinical Benefit With Nivolumab Plus Ipilimumab in DNA Mismatch Repair-Deficient/Microsatellite Instability-High Metastatic Colorectal Cancer. J Clin Oncol, Mar 10 2018; 36(8): 773-779. Go to original source...
  68. Chen Y, Chi P. Basket trial of TRK inhibitors demonstrates efficacy in TRK fusion-positive cancers. Journal of hematology & oncology, 2018; 11(1): 78-78. Go to original source... Go to PubMed...
  69. Drilon A, Nagasubramanian R, Blake JF, Ku N, et al. A Next-Generation TRK Kinase Inhibitor Overcomes Acquired Resistance to Prior TRK Kinase Inhibition in Patients with TRK Fusion-Positive Solid Tumors. Cancer discovery, 2017; 7(9): 963-972. Go to original source... Go to PubMed...
  70. Siena S, Sartore-Bianchi A, Marsoni S, Hurwitz HI, et al. Targeting the human epidermal growth factor receptor 2 (HER2) oncogene in colorectal cancer. Annals of oncology : official journal of the European Society for Medical Oncology, 2018; 29(5): 1108-1119. Go to original source...
  71. Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget, 2015; 6(11): 8491-8524. Go to original source... Go to PubMed...
  72. Stewart, CL, Warner S, Ito K, Raoof M, et al. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Current problems in surgery, 2018; 55(9): 330-379. Go to original source... Go to PubMed...




Oncology

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.