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Pericay C, Montagut C, Reina JJ, Melian M, Alcaide J, Tarazona N, Ruiz-Casado A, González-Flores E, Graña B, Grávalos C. SEOM-GEMCAD-TTD clinical guidelines for the adjuvant treatment of colon cancer (2023). Clin Transl Oncol 2024:10.1007/s12094-024-03559-5. [PMID: 38914755 DOI: 10.1007/s12094-024-03559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/26/2024]
Abstract
Colorectal cancer (CRC) has a 5-year overall survival rate of over 60%. The decrease in the rate of metastatic disease is due to screening programs and the population's awareness of healthy lifestyle. Similarly, advancements in surgical methods and the use of adjuvant chemotherapy have contributed to a decrease in the recurrence of resected disease. Before evaluating a patient's treatment, it is recommended to be discussed in a multidisciplinary tumor board. In stage II tumors, the pathologic characteristics of poor prognosis must be known (T4, number of lymph nodes analyzed less than 12, lymphovascular or perineural invasion, obstruction or perforation, poor histologic grade, presence of tumor budding) and it is mandatory to determine the MSI/MMR status for avoiding administering fluoropyridimidines in monotherapy to patients with MSI-H/dMMR tumors. In stage III tumors, the standard treatment consists of a combination of fluoropyrimidine (oral or intravenous) with oxaliplatin for 6 months although the administration of CAPOX can be considered for 3 months in low-risk tumors. Neoadjuvant treatment is not consolidated yet although immunotherapy is achieving very good preliminary results in MSI-H patients. The use of ctDNA to define the treatment and monitoring of resected tumors is only recommended within studies. These guidelines are intended to help decision-making to offer the best management of patients with non-metastatic colon cancer.
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Affiliation(s)
- Carles Pericay
- Medical Oncology Department, Hospital University, Mútua de Terrassa, Barcelona, Spain.
| | - Clara Montagut
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Juan José Reina
- Medical Oncology Department, Hospital University, Virgen Macarena, Seville, Spain
| | | | - Julia Alcaide
- Medical Oncology Department, Hospital University, Regional y Virgen de la Victoria, Málaga, Spain
| | - Noelia Tarazona
- Medical Oncology Department, Hospital Clínico University de Valencia, Valencia, Spain
| | - Ana Ruiz-Casado
- Medical Oncology Department, H.U. Puerta de Hierro, Madrid, Spain
| | | | - Begoña Graña
- Medical Oncology Department, Complexo Hospitalario Universitario, A Coruña, Spain
| | - Cristina Grávalos
- Medical Oncology Department, Instituto de Investigacion Sanitaria Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
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Sun J, Wei Y, Wang J, Hou M, Su L. Treatment of colorectal cancer by traditional Chinese medicine: prevention and treatment mechanisms. Front Pharmacol 2024; 15:1377592. [PMID: 38783955 PMCID: PMC11112518 DOI: 10.3389/fphar.2024.1377592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
Colorectal cancer (CRC) is a significant global health burden, with high morbidity and mortality rates. It is often diagnosed at middle to advanced stage, affecting approximately 35% of patients at the time of diagnosis. Currently, chemotherapy has been used to improve patient prognosis and increase overall survival. However, chemotherapy can also have cytotoxic effects and lead to adverse reactions, such as inhibiting bone marrow hematopoiesis, causing digestive dysfunction, hand-foot syndrome, and even life-threatening conditions. In response to these adverse effects, researchers have proposed using Traditional Chinese Medicine (TCM) as an option to treat cancer. TCM research focuses on prescriptions, herbs, and components, which form essential components of the current research in Chinese medicine. The study and implementation of TCM prescriptions and herbs demonstrate its distinctive holistic approach to therapy, characterized by applying multi-component and multi-target treatment. TMC components have advantages in developing new drugs as they consist of single ingredients, require smaller medication dosages, have a precise measure of pharmacodynamic effects, and have a clear mechanism of action compared to TCM prescriptions and herbs. However, further research is still needed to determine whether TMC components can fully substitute the therapeutic efficacy of TCM prescriptions. This paper presents a comprehensive analysis of the research advancements made in TCM prescriptions, herbs, and components. The findings of this study can serve as a theoretical basis for researchers who are interested in exploring the potential of TCM for the treatment of colorectal cancer.
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Affiliation(s)
- Jiaxin Sun
- Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, Hohhot, Inner Mongolia, China
| | - Ying Wei
- Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, Hohhot, Inner Mongolia, China
| | - Jia Wang
- Department of Gynaecology, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia, China
| | - Mingxing Hou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Liya Su
- Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, Hohhot, Inner Mongolia, China
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Piercey O, Wong HL, Leung C, To YH, Heong V, Lee M, Tie J, Steel M, Yeung JM, McCormick J, Gibbs P, Wong R. Adjuvant Chemotherapy for Older Patients With Stage III Colorectal Cancer: A Real-World Analysis of Treatment Recommendations, Treatment Administered and Impact on Cancer Recurrence. Clin Colorectal Cancer 2024; 23:95-103.e3. [PMID: 38242766 DOI: 10.1016/j.clcc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND A substantial proportion of patients with stage III colorectal cancer (CRC) are older than 70 years. Optimal adjuvant chemotherapy (AC) for older patients (OP) continues to be debated, with subgroup analyses of randomized trials not demonstrating a survival benefit from the addition of oxaliplatin to a fluoropyrimidine backbone. PATIENTS AND METHODS We analyzed the multisite Australian ACCORD registry, which prospectively collects patient, tumor and treatment data along with long term clinical follow-up. We compared OP (≥70) with stage III CRC to younger patients ([YP] <70), including the proportion recommended AC and any reasons for not prescribing AC. AC administration, regimen choice, completion rates, and survival outcomes were also examined. RESULTS One thousand five hundred twelve patients enrolled in the ACCORD registry from 2005 to 2018 were included. Median follow-up was 57.0 months. Compared to the 827 YP, the 685 OP were less likely to be offered AC (71.5% vs. 96.5%, P < .0001) and when offered, were more likely to decline treatment (15.1% vs. 2.8%, P < .0001). Ultimately, 60.0% of OP and 93.7% of YP received AC (P < .0001). OP were less likely to receive oxaliplatin (27.5% vs. 84.7%, P < .0001) and to complete AC (75.9% vs. 85.7%, P < .0001). The probability of remaining recurrence-free was significantly higher in OP who received AC compared to those not treated (HR 0.73, P = .04) but not significantly improved with the addition of oxaliplatin (HR 0.75, P = .18). CONCLUSION OP were less likely than YP to receive AC. Receipt of AC reduced recurrences in OP, supporting its use, although no significant benefit was observed from the addition of oxaliplatin.
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Affiliation(s)
- Oliver Piercey
- Peter MacCallum Cancer Centre, Melbourne, Australia; The University of Melbourne, Parkville, Australia.
| | - Hui-Li Wong
- Peter MacCallum Cancer Centre, Melbourne, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Clara Leung
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yat Hang To
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Valerie Heong
- The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Margaret Lee
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Eastern Health, Box Hill, Australia; Western Health, St Albans, Australia; Monash University, Eastern Health Clinical School, Box Hill, Australia
| | - Jeanne Tie
- Peter MacCallum Cancer Centre, Melbourne, Australia; The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | | | - Justin M Yeung
- The University of Melbourne, Parkville, Australia; Western Health, St Albans, Australia
| | - Jacob McCormick
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne Health, Parkville, Australia
| | - Peter Gibbs
- The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Western Health, St Albans, Australia
| | - Rachel Wong
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Eastern Health, Box Hill, Australia; Monash University, Eastern Health Clinical School, Box Hill, Australia
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Ioffe D, Dotan E. Guidance for Treating the Older Adults with Colorectal Cancer. Curr Treat Options Oncol 2023; 24:644-666. [PMID: 37052812 DOI: 10.1007/s11864-023-01071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/14/2023]
Abstract
OPINION STATEMENT The need for evidence-based data in the rapidly growing group of older patients is vast and more elderly-specific studies are desperately needed, for which there is clear demand from both patients and providers. Notably, many of the studies discussed in this review included unplanned subset analyses based on age and/or were not originally stratified by age; therefore, these data, particularly overall survival data, need to be interpreted with some caution as they may not be statistically valid based on the initial trial design and statistical plan. As we await data from ongoing elderly-specific trials, our recommendation for managing older patients with CRC should include geriatric screening tools (e.g., CSGA, VES-13, G8, CARG, CRASH) to help guide treatment adjustments for improved tolerability without sacrificing efficacy. For patients with a positive screen for significant geriatric concerns, a full geriatric assessment is recommended to guide treatment approach and supportive care. Prior data support the use of all approved medications for CRC in older adults who are fit; however, treatment breaks and dose attenuation with potential escalation are reasonable options for these patients. Ultimately, management decisions in the care of older adults with mCRC must be made through shared decision-making with the patient with consideration for the patient's functional status, comorbidities, goals of care, social support, as well as potential toxicities and possible effect on QoL.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
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