ESMO E-Learning: Optimising Outcomes for Patients with Advanced Colorectal Cancer

Learning Objectives

  • Provide essentials of continuum of care approach for patients with advanced colorectal cancer within a multidisciplinary team setting
  • Provide an update on Biomarker-driven therapeutic strategies in patients with advanced colorectal cancer 
  • Provide an update on different treatment modalities and management scenarios in patients with advanced colorectal cancer  
Title Duration Content CME Points CME Test
Optimising Outcomes for Patients with Advanced Colorectal Cancer 51 min. 43 slides 1 Take Test
gkolfinopuolos-stavros
Stavros Gkolfinopoulos
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George Pentheroudakis
George Pentheroudakis
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Demetris Papamichael
Demetris Papamichael
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This E-learning module presents the state-of-the science treatment approaches in 2016 for patients with metastatic colorectal cancer (mCRC) in the context of multidisciplinary team (MDT) management. The survival of patients with mCRC can be optimised by the integration of systemic therapy, surgical resection and ablative modalities, where appropriate, preferably in a MDT setting. Several studies have shown improved clinical outcomes when patients with CRC are managed by MDTs. 

CRC is the second most commonly diagnosed cancer in Europe with a worldwide incidence of 1.4 million new cases, corresponding to 694,000 deaths annually. Metastatic disease is a major cause of cancer-related mortality and currently the median overall survival for mCRC patients is 30 months. Insights into the biology of the disease and Biomarker-driven therapeutic strategies are expected to improve survival and rationalise therapeutic approaches.

Standardisation of tissue processing for patients with mCRC still remains a challenge. In this E-Learning module the authors describe the central role of pathologists in tissue handling, histology and biomarker assessment.

RAS testing should be performed on tumour tissues of all patients at the time of diagnosis of mCRC and is mandatory prior to treatment with EGFR-targeted monoclonal antibodies. RAS analysis should include at least KRAS exons 2, 3 and 4 and NRAS exons 2, 3 and 4. Laboratories providing RAS testing of colorectal tumours should demonstrate successful participation in a relevant external quality assessment scheme, and be appropriately accredited. Tumour BRAF mutation status should be assessed alongside the assessment of tumour RAS mutational status for prognostic assessment (and/or potential selection for clinical trials). In the metastatic disease setting, MSI testing is recommended for genetic counselling purposes and emerging data show its predictive value for the use of immune check-point inhibitors.

In this module, the authors underline that the goal of treatment in mCRC patients with liver metastases is complete resection and explain the technical and oncological criteria of resectability. Treatment strategies for patients with oligometastatic disease should be based on the possibility of achieving complete ablation of all tumour masses. 

Two categories are evolving for the systemic treatment of ‘fit’ patients with CRC, whose metastatic disease is not resectable at presentation:

1) Those for whom intensive treatment is appropriate and necessary - the so called cytoreduction group;

2) The disease control group, in those patients for whom an intensive treatment is not necessary and where the goal is to control progression of the disease.

For patients in both categories, the knowledge of the RAS and BRAFmutational status is used to further refine treatment strategies.

The authors present the sequence of treatment and timelines in continuum of care for patients with mCRC. They elaborate drivers for first-line treatment based on tumour, patient and treatment characteristics. Biologicals (targeted agents) are indicated in the first-line treatment of most patients, unless contraindicated. For maintenance therapy, they highlight that individualisation and discussion with the patient is essential. Second-line treatment scenarios are described: either initial induction therapy or a second-line therapy should be reintroduced at radiological or first signs of symptomatic progression. The options for third-line treatment options are also discussed.

 

Last update: 01 July 2016

Prof Pentheroudakis has reported to have received research support and fees for advisory services from Amgen, Roche and Merck.

Prof Papamichael has reported to have received funding for advisory board services and Speakers Bureau from Amgen, Roche and Merck.

Dr Gkolfinopoulos has reported no conflict of interest.