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ESMO E-Learning: Optimising Outcomes For Patients With Advanced Colorectal Cancer

E-learning video block

This content is for ESMO members only.



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Learning objectives

  1. Provide current state of the art in terms of systemic therapy for unresectable advanced colorectal cancer
  2. Elaborate the importance of tumour sidedness, molecular pathology and new actionable targets
  3. Provide principles in the treatment of oligometastatic advanced colorectal cancer


In this E-Learning module, the authors emphasise that the survival of patients with metastatic colorectal cancer (CRC) can be optimised through the integration of systemic therapy, surgical resection and ablative modalities, where appropriate, preferably in a multidisciplinary team setting. Insights in the biology of the disease and biomarker-driven therapeutic strategies are expected to improve survival and rationalise therapeutic approaches. Furthermore, basic and translational cancer research leading to well defined hypotheses that are tested in appropriately stratified and molecularly-enriched clinical trials is the way forward.

The authors have divided the module into three parts. In the first part, the authors underline that the optimal sequencing of currently available therapies for non-resectable metastatic disease remains to be elucidated in terms of toxicity and patient’s tolerance, as well as biomarkers. The authors discuss tumour, patient’s and treatment characteristics as factors to decide about first-line treatment.

The authors elaborate current options for first-line therapy through answering the questions such as:

Does a combination strategy outperform sequential treatment?

What does bevacizumab add to the outcome?

What do EGFR inhibitors add to outcome in case of KRAS wt colorectal cancer? Should we add bevacizumab or an EGFR inhibitor in case of Ras wt colorectal cancer?

They provide the recommendations for RAS and BRAF mutations testing and elaborate atypical BRAF mutations. They also show evidence for continous versus intermitent first-line systemic therapy, the results from the clinical trials in second-line treatment, as well as standard and emerging options beyond second-line.  

Standardisation of the tissue processing for patients with metastatic CRC remains a challenge. In the second part of the module, beyond tissue handling, the authors elaborate actionable molecular aberrations, primary tumour sidedness, the importance of information in terms of microsatellite instability (MSI) status, the results from the studies with immune checkpoint inhibitors in MSI-high/MMR-deficient tumours, as well as findings from studies targeting HER2, NTRK fusions. They summarise the treatment options according to specific biomarkers and introduce a concept of liquid biopsy in CRC.

This part of the module is completed with information on the consensus molecular subtypes of CRC.

The last part of the module is dedicated to the management of oligometastatic disease: the treatment goal, principles of resection of colorectal, liver metastases, as well as induction chemotherapy for patients with borderline resectable metastases.

Declaration of interest

George Pentheroudakis has reported:
Consulting and advisory services, speaking or writing engagements, public presentations: Amgen,Merck, AstraZeneca, Roche, BMS, MSD, Lilly.
Direct research support to the responsible project lead (e.g., Principal Investigator): Boehringer, Merck, Amgen, AstraZeneca, Roche, Enorasis, BMS, Lilly.
Financial support for clinical trials or contracted research: Boehringer, Merck, Amgen, AstraZeneca, Roche, Lilly, Abbvie, Debiopharm, Ipsen.
Member, Scientific Committtee of the Hellenic Cooperative Oncology Group.
Coordinating investigator in HeCOG-sponsored clinical trials.
Board, Society for Study of Clonal Heterogeneity of Neoplasia.
ESMO Chief Medical Officer (ESMO staff).

Demetris Papamichael has reported:
Honoraria for Speaker at Satellite Symposia: Merck Serono, Roche, Amgen.
Honoraria for Advisory Board: Merck Serono, Novartis, Sanofi.
Travel Grants: Roche, Merck Serono, MSD, Servier.
IDMC member for SOLSTICE - clinical trial: Servier.
Research grant to his Institution: MSD.
Member Education Committee, ESMO.
ESMO/SIOG Working Group co-Chair.
International Society of Geriatric Oncology: Membership and National Representatives Committee.
Gastrointestinal Programme Co-ordinator for the European School of Oncology.
Member of the Board - Cyprus Cancer Research Institute.

George Zarkavelis has reported:
Speaker honoraria: Amgen and Ipsen.

Anna Lea Amylidi has reported no conflicts of interest.

Henk Van Halteren has reported no conflicts of interest.

Last update: 23 Feb 2021

This E-Learning module was published in 2021. The CME test expired in 2023.

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