The Role of Neoadjuvant Chemotherapy in Patients With Resectable Colorectal Metastases: Where Are We Now?
Abstract
Approximately 25 % of patients with colorectal cancer (CRC) have colorectal liver metastases (CRLMs) at the time of diagnosis, and up to 60 % of CRC patients will develop CRLM during the course of their disease. Complete surgical resection of CRLM affords patients the possibility of long-term cure. With modern chemotherapy, shrinkage in the size of unresectable CRLM may allow patients to undergo surgery. However, the role of chemotherapy given prior to surgery for patients with already-resectable CRLM at the time of presentation is unclear. Currently, the use of neoadjuvant chemotherapy (NAC) i...
Source: Current Colorectal Cancer Reports - January 16, 2016 Category: Cancer & Oncology Source Type: research
The Outlook for Immune Checkpoint Targeting Strategies in Colorectal Cancer
Abstract
Encouraging clinical activity for checkpoint blockade in melanoma, lung cancer, and a growing list of other malignancies has supported enthusiasm for testing this strategy in colorectal cancer. Although frequent observations of T cell infiltration into colorectal cancer and a well-established list of target antigens suggest colorectal cancer should be amenable to this approach, there was limited clinical evidence until recent demonstration of substantial activity for anti-PD-1 antibody therapy in microsatellite instability high colorectal cancers. Addition of other therapeutic modalities such as ...
Source: Current Colorectal Cancer Reports - January 16, 2016 Category: Cancer & Oncology Source Type: research
Genetic Basis for Colorectal Cancer Disparities
Abstract
African Americans suffer the highest burden from colorectal cancer (CRC) in the USA. Studies have suggested that healthcare access and poorer utilization of preventive services may be playing more of a role in this disparity. However, African Americans also tend to develop CRC at younger ages and are more likely to have proximal cancers. This raises the possibility of higher genetic predisposition to CRC among African Americans and this has not been well studied. In this article, we reviewed possible genetic basis underpinning biological differences in CRC burden in the USA. (Source: Current Colo...
Source: Current Colorectal Cancer Reports - November 11, 2015 Category: Cancer & Oncology Source Type: research
Markers in Colorectal Cancer and Clinical Trials Based Upon Them
Abstract
Colorectal cancer was a model for the early discovery of processes of carcinogenesis at a molecular level, yet despite this, therapeutic advances have been slow. A gradual appreciation of the influence of signaling through the Ras/Raf/MEK pathway showed that tumors carrying mutations in this pathway were resistant to EGFR inhibition, but it has not been until recently that targeting this pathway has yielded therapeutic efficacy. Patients with tumors carrying a mutant BRAF are responsive to combined approaches to the pathway. In 2015, reports have also been presented to show the effect of targetin...
Source: Current Colorectal Cancer Reports - October 21, 2015 Category: Cancer & Oncology Source Type: research
Angioprevention in Colon Cancer from Bench to Bedside
Abstract
Colon cancer is a deadly disease with an indolent growth pattern that provides a window of opportunity for early detection and a platform for effective prevention. Angiogenesis has been implicated in the transformation of a colonic adenoma into polyp and ultimately into cancer, invading the neighboring tissue and gaining access to systemic circulation before seeding into distant organs. The “angiogenic switch” that occurs early during the preneoplastic stages could be controlled by “angiopreventive” agents before phenotypic and molecular changes result in the progression from dysplasia to...
Source: Current Colorectal Cancer Reports - October 12, 2015 Category: Cancer & Oncology Source Type: research
Epigenetic and Immune Regulation of Colorectal Cancer Stem Cells
Abstract
Colorectal cancer stem cells (CSCs) were initially considered to be a subset of undifferentiated tumor cells with well-defined phenotypic and molecular markers. However, emerging evidence indicates instead that colorectal CSCs are heterogeneous subsets of tumor cells that are continuously reshaped by the dynamic interactions between genetic, epigenetic, and immune factors in the tumor microenvironment. Thus, the colorectal CSC phenotypes and responsiveness to therapy may not only be a tumor cell-intrinsic feature but also depend on tumor-extrinsic microenvironmental factors. Furthermore, emerging...
Source: Current Colorectal Cancer Reports - October 10, 2015 Category: Cancer & Oncology Source Type: research
Are There Strategies to Integrate the Continuum of Care for Metastatic Colorectal Cancer When Resources Are Limited?
Abstract
Colorectal cancer is one of the most frequent neoplasias worldwide, affecting both men and women. Patients with inoperable or metastatic colorectal cancer (CRC) are candidates for palliative treatment with chemotherapy, which can significantly prolong survival. The number of active drugs has progressively increased over the past years, as well as available techniques directed towards resection or ablation of metastasis. Consequently, patients are able to live longer, with better quality of life. As new technologies become available, the treatments are becoming increasingly complicated, and the co...
Source: Current Colorectal Cancer Reports - October 5, 2015 Category: Cancer & Oncology Source Type: research
Clinical Complete Response After Neoadjuvant Therapy in Rectal Cancer: Is Surgery Needed?
Abstract
Neoadjuvant chemoradiation followed by proctectomy is the recommended treatment plan for locally advanced rectal cancer in the USA. After chemoradiation, approximately 20 % of patients experience a complete pathologic response, which is associated with improved oncological outcomes. This observation prompted questions about the necessity of surgery if the tumor has completely regressed. Using clinical complete response as a surrogate for pathologic response, the watch and wait approach was introduced as an attempt at organ preservation utilizing active surveillance protocols rather than surgery....
Source: Current Colorectal Cancer Reports - October 3, 2015 Category: Cancer & Oncology Source Type: research
New Adjuvant Trial Designs in Colon Cancer
Abstract
The treatment of colon cancer has evolved significantly since the discovery of 5-fluorouracil, and with continued innovation, it will continue to advance for the foreseeable future. In this review, we identify and discuss novel adjuvant trial designs which are currently being employed and that are forthcoming in the treatment of colon cancer. Novel approaches include investigation into whether a shorter duration of adjuvant therapy is as effective as the current standard, whether there is benefit of neoadjuvant chemotherapy in the treatment of nonmetastatic colon cancer, the role of circulating t...
Source: Current Colorectal Cancer Reports - September 28, 2015 Category: Cancer & Oncology Source Type: research
BRAF Mutations in Non-Metastatic Colorectal Cancer: Current Relevance and Future Implications
Abstract
BRAF
V600E-mutated colorectal cancer (CRC) is a distinct entity that accounts for less than 10 % of all CRC patients and is associated with unique clinical and pathologic features. This biomarker also confers a poor prognostic outcome across all stages of CRC relative to wild-type counterparts. Currently, the landscape of effective therapies, both in terms of adjuvant treatment and in the metastatic setting, remains limited. This review will detail the role of the BRAF
V600E mutation as a prognostic biomarker in th...
Source: Current Colorectal Cancer Reports - September 24, 2015 Category: Cancer & Oncology Source Type: research
Blood Tests for Colorectal Cancer Screening in the Standard Risk Population
Abstract
Barriers to screening for colorectal cancer (CRC) might be circumvented by using a blood test. New blood markers continue to be discovered, comprising RNA, DNA, and protein. On reviewing the literature on biomarkers in blood, many potentially valuable markers have been described. Those based on DNA have been the best evaluated to date and are not subject to the same specificity problems as fecal immunochemical tests (FIT), but as a class have relatively poorer sensitivity for adenomas. Most other markers have not been taken beyond the most rudimentary clinical assessment, and extremely few have b...
Source: Current Colorectal Cancer Reports - September 21, 2015 Category: Cancer & Oncology Source Type: research
Epigenetics and Colorectal Neoplasia: the Evidence for Physical Activity and Sedentary Behavior
We describe the evidence for epigenetic variation as a link between physical activity and sedentary behavior in colorectal neoplasia risk. There are few studies that directly evaluate this relationship. However, the growing literature describes a variety of gene targets influenced by activity that are also important to colorectal neoplasia etiology. Future studies may identify epigenetic markers with translational significance in identifying high-risk individuals or those for whom a personalized activity regimen could significantly alter the methylation signature in colon epithelial cells, and thus future risk of colorecta...
Source: Current Colorectal Cancer Reports - September 19, 2015 Category: Cancer & Oncology Source Type: research
How Should a Multi-disciplinary Team (MDT) Approach the Issue of Non-Operative Management in Rectal Cancer?
Abstract
A sustained clinical complete response (CCR) after preoperative chemoradiation (CRT) is observed in 10–20 % of patients with locally advanced rectal cancer (LARC). A selective non-operative management with close surveillance is increasingly being advocated for patients achieving a CCR—on the assumption that outcomes compare favourably with patients subjected to radical surgery (usually requiring a permanent stoma). The aim of this present opinion piece was to capture individual views of an MDT and elicit common themes regarding the question “How should a multi-disciplinary team (MDT) appro...
Source: Current Colorectal Cancer Reports - September 16, 2015 Category: Cancer & Oncology Source Type: research
Update on Anti-angiogenesis Therapy in Colorectal Cancer
Abstract
Angiogenesis is a complex biologic process critical to growth and proliferation of colorectal cancer. The safety and efficacy of various anti-angiogenic agents have been investigated in many treatment settings. Bevacizumab, an anti-vascular endothelial growth factor agent, has efficacy in both the first-line setting and beyond progression in metastatic colorectal cancer. The decoy vascular endothelial growth factor receptor aflibercept has been approved in combination with 5-fluorouracil-, leucovorin-, and irinotecan-based chemotherapy in metastatic colorectal cancer patients whose disease has pr...
Source: Current Colorectal Cancer Reports - September 3, 2015 Category: Cancer & Oncology Source Type: research
FIRE-3 and C80405: Is There a Best Choice for Initial Treatment of Metastatic Colorectal Cancer?
Abstract
In the treatment of metastatic colorectal cancer, chemotherapy is used as a backbone to which an angiogenesis inhibitor such as bevacizumab (vascular endothelial growth factor [VEGF]) or a monoclonal antibody to the epidermal growth factor receptor (EGFR) such as cetuximab or panitumumab is added. In this article, we seek answers to the question: “FIRE-3 and C80405: is there a best choice for initial treatment of metastatic colorectal cancer?” In the absence of clear and univocal evidence that EGFR inhibitors should be used in the first-line setting for patients with metastatic RAS wild-type ...
Source: Current Colorectal Cancer Reports - September 2, 2015 Category: Cancer & Oncology Source Type: research
