Meeting the biologic challenge of colorectal metastases Journal Article
| Authors: | Wanebo, H. J.; LeGolvan, M.; Paty, P. B.; Saha, S.; Zuber, M.; D'Angelica, M. I.; Kemeny, N. E. |
| Article Title: | Meeting the biologic challenge of colorectal metastases |
| Abstract: | An overview of colorectal cancer discussed (Philip Paty) the good outcome after primary management with local control in 90-95 % of colon and 85 % in rectal cancer patients with major progression to metastases and to death related to hematogenous dissemination. The major disease pathways include the APC, aneuploid pathway involving mutations of P53, KRAS, SMAD 4, or the CMP/ MSI pathway, mismatched repair defect as characterized by additional question reviewed related to the role of neoadjuvant systemic chemotherapy (with response rates in the 50 % range) to produce down staging of the hepatic metastases and allow one to retrieve these patients with possible residual disease. In a series of 116 patients who had hepatic resection of CRC metastases in presence of regional node metastases, post neoadjuvant chemotherapy (normally not candidates for resection) these patients were demonstrated to have a 95 % recurrence at median time of 9 months. This raises a cautionary note to the literature report of five-year survivals in the 20-30 % range for hepatic metastases in presence of extra hepatic disease. Such may reflect patient selection rather than a true measure of the biology of disease, and warrant clinical trial evaluation. Lastly, regional therapy and overall systemic therapy were addressed by Dr. Kemeny. The CALGB study of hepatic artery infusion (HAI) with FUDR, dexamethasone versus 5FU leucovorin showed an overall survival of 24.4 months with HAI versus 20 months with systemic therapy (P = 0.0034). An adjuvant trial of HAI at MSK in 156 patients showed an overall survival benefit at 2 year and recent long term 10yr follow-up showing a significant overall survival of 41 % with HAI versus 27 % with systemic therapy (5FU leucovorin). In the neoadjuvant Nordlinger trial for hepatic metastases, there was a significant outcome differences-the preoperative therapy group had 9.2 % increase of progression free survival versus the surgery alone group which suggests the value of combining neoadjuvant surgery in good risk liver resection candidates. Conclude the final lesson from this well presented mini symposium confirms the need for continued evaluation of the numerous discussion points by clinical trial. © Springer Science+Business Media B.V. 2012. |
| Keywords: | immunohistochemistry; signal transduction; cancer survival; treatment outcome; treatment response; cancer surgery; survival rate; unclassified drug; gene mutation; overall survival; proto-oncogene proteins; cancer recurrence; bevacizumab; fluorouracil; placebo; cancer growth; patient selection; liver neoplasms; conference paper; cancer staging; outcome assessment; follow up; lymph node metastasis; sentinel lymph node biopsy; colorectal cancer; metastasis; progression free survival; reverse transcription polymerase chain reaction; apoptosis; gene expression; epidermal growth factor receptor; genetic association; dexamethasone; angiogenesis; surgical approach; cetuximab; protein p53; cancer survivor; carcinogenesis; irinotecan; panitumumab; colorectal neoplasms; cancer invasion; survival time; liver metastasis; folinic acid; colon cancer; mismatch repair; clinical evaluation; matrix metalloproteinase; neoplasm metastasis; smad proteins; tumor suppressor protein p53; intestine resection; ras proteins; diagnostic test; cancer control; oxaliplatin; k ras protein; floxuridine; rectum cancer; aneuploidy; colorectal neoplasms, hereditary nonpolyposis; b raf kinase; cholecystitis; apc protein; hepatic artery; hereditary nonpolyposis colorectal cancer; tissue inhibitor of metalloproteinase; cell adhesion molecule; signaling pathways; catheter thrombosis; colorectal metastasis; catheter complication; epithelial mesenchymal transition; smad4 protein; adenomatous polyposis coli; regional therapy; nucleic acid amplification; cancer prognosis; sentinel lymph nodes liver metastasis; capecitabine plus oxaliplatin; cytidine phosphate; ms1 protein; hepatic artery thrombosis; one step nucleic acid diagnostic system |
| Journal Title: | Clinical and Experimental Metastasis |
| Volume: | 29 |
| Issue: | 7 |
| ISSN: | 0262-0898 |
| Publisher: | Springer |
| Date Published: | 2012-10-01 |
| Start Page: | 821 |
| End Page: | 839 |
| Language: | English |
| DOI: | 10.1007/s10585-012-9517-x |
| PROVIDER: | scopus |
| PUBMED: | 23053740 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 3 December 2012" - "CODEN: CEXMD" - "Source: Scopus" |
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