Treatment Individualization in Colorectal Cancer
Abstract
Colorectal cancer has been characterized as a genetically heterogeneous disease, with a large diversity in molecular pathogenesis resulting in differential responses to therapy. However, the currently available validated biomarkers KRAS, BRAF, and microsatellite instability do not sufficiently cover this extensive heterogeneity and are therefore not suitable to successfully guide personalized treatment. Recent studies have focused on novel targets and rationally designed combination strategies. Furthermore, a more comprehensive analysis of the underlying biology of the disease revealed distinct p...
Source: Current Colorectal Cancer Reports - August 26, 2015 Category: Cancer & Oncology Source Type: research
Complex Surgical Strategies to Improve Resectability in Borderline-Resectable Disease
Abstract
Colorectal cancer is the third most common malignancy in the USA and continues to pose a significant epidemiologic problem, despite major advances in the treatment of patients with advanced disease. Up to 50 % of patients will develop metastatic disease at some point during the course of their disease, with the liver being the most common site of metastatic disease. In this review, we address the relatively poorly defined entity of borderline-resectable colorectal liver metastases. The workup and staging of borderline-resectable disease are discussed. We then discuss management strategies, inclu...
Source: Current Colorectal Cancer Reports - August 17, 2015 Category: Cancer & Oncology Source Type: research
The Role of Intensity-Modulated Radiotherapy to Optimize Outcomes in Locally Advanced Rectal Cancer
Abstract
Intensity-modulated radiation therapy (IMRT) as neoadjuvant treatment of locally advanced rectal cancer (LARC) patients has been explored by some authors since 2006. Dosimetrical analyses and clinical outcomes have been published in recent years. Although there are encouraging dosimetrical results, there are no solid clinical data supporting the routine use of IMRT for preoperative treatment of LARC patients. In this article, we analyze the published dosimetrical and clinical data and current evidence for the use of IMRT in LARC patients. We hypothesize the role of IMRT to treat rectal cancer pat...
Source: Current Colorectal Cancer Reports - August 15, 2015 Category: Cancer & Oncology Source Type: research
New Neoadjuvant Treatment Strategies for Non-Metastatic Rectal Cancer (M0)
Abstract
Rectal cancers stages II–III are presenting many various clinical situations. Neoadjuvant chemoradiotherapy is a standard of care in many cases, and in association with TME surgery, local relapses are becoming uncommon. None of these neoadjuvant treatments have so far improved survival, and quality of life remains non-optimal after abdomino-perineal resection and quite often after anterior resection. To increase survival through sterilization of subclinical distant metastases, new induction chemotherapy is tested. In T4 tumors, radiation dose escalation should be able to further improve local c...
Source: Current Colorectal Cancer Reports - August 12, 2015 Category: Cancer & Oncology Source Type: research
Neoadjuvant Rectal (NAR) Score: a New Surrogate Endpoint in Rectal Cancer Clinical Trials
Abstract
The conduct of clinical trials in colorectal cancer has historically relied upon endpoints such as disease-free (DFS) or overall survival (OS). While ideal, these endpoints require long-term follow-up, thus contributing to a slow pace of scientific progress in clinical research. Identification of short-term endpoints to serve as surrogates for DFS and OS would enable more rapid determination of success or failure of an experimental intervention and thus facilitate more scientific discovery and progress leading to clinical practice improvements. In rectal cancer clinical trials, there have been fe...
Source: Current Colorectal Cancer Reports - August 9, 2015 Category: Cancer & Oncology Source Type: research
“The Role of Primary Tumor Resection (PTR) in Metastatic Colorectal Cancer”
Abstract
Patients with unresectable metastatic colorectal cancer can either receive systemic chemotherapy as first treatment or have a palliative resection of the primary tumor or endoscopic placement of a self-expanding metallic stent if they present with colonic obstruction. The ongoing dilemma is whether resection of the primary tumor in asymptomatic patients is beneficial. The effectiveness of current systemic treatment regimens on the primary tumor as well as the survival benefit of primary tumor resection in the era of new chemotherapy agents, biologics, and targeted therapy is underreported. No pro...
Source: Current Colorectal Cancer Reports - August 6, 2015 Category: Cancer & Oncology Source Type: research
The Increasing Relevance of Tumour Histology in Determining Oncological Outcomes in Colorectal Cancer
Abstract
Colorectal cancer is not just one type of cancer. Differences in outcome and reaction to treatment can at least be partly explained by different histological and molecular subtypes. Recognition of these differences may influence treatment decisions. However, there is huge variation in the amount of information that is available. Several tumour types such as mucinous carcinoma, signet ring cell carcinoma, neuroendocrine carcinoma and adenosquamous carcinoma have such a distinct phenotype that they are readily recognised. However, due to the rarity of signet ring cell carcinoma and adenosquamous ca...
Source: Current Colorectal Cancer Reports - August 2, 2015 Category: Cancer & Oncology Source Type: research
Radiation Techniques for Increasing Local Control in the Non-Surgical Management of Rectal Cancer
This report discusses several radiotherapy techniques for tumour boosting, focusing on technical challenges and clinical experiences with each technique. Specifically, external beam radiotherapy, brachytherapy and contact X-ray treatment for dose escalation are considered. Ultimately, no technique provides definitive advantage over others, and the choice in clinical practice will have to depend on the patient population treated as well as the technical capabilities of the treating department. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - July 28, 2015 Category: Cancer & Oncology Source Type: research
Distinctive Tumor Biology of MSI-High Colorectal Cancer
Abstract
High-frequency microsatellite instability (MSI-H) accounts for roughly 15 % of all cases of colorectal cancer (CRC) and results from pathogenic mutations or epigenetic changes in mismatch repair (MMR) proteins, primarily MLH1, MSH2, MSH6, and PMS2. These alterations can be inherited, as in the case of Lynch syndrome, or can be acquired sporadically, including cases of epigenetic alteration along crucial regulatory sequences. Cancers that develop in the setting of MSI-H possess a unique clinicopathologic phenotype, with a high degree of mutation resulting in potential recognition by the immune sy...
Source: Current Colorectal Cancer Reports - July 23, 2015 Category: Cancer & Oncology Source Type: research
Biomarkers of Inflammation and Immune Function and Risk of Colorectal Cancer
Abstract
A substantial number of prospective epidemiological studies have been conducted to investigate the association between biomarkers of inflammation and immune function and risk of colorectal cancer. Although pre-diagnostic concentrations of these biomarkers, especially C-reactive protein, have been associated with a higher risk of colorectal cancer in some studies, this association does not seem to have a robust support without hints of bias. Future prospective studies should evaluate multiple inflammatory biomarkers with longitudinal measures over the follow-up taking advantage of new multiplex cy...
Source: Current Colorectal Cancer Reports - July 23, 2015 Category: Cancer & Oncology Source Type: research
Local Therapy Options for Oligometastatic Disease in the Liver
Abstract
Our understanding of metastatic disease is constantly evolving. Survival outcomes for patients with colorectal cancer metastatic to the liver are poor, although a subset of patients with limited or “oligometastatic” disease may exist in a therapeutic window amenable to aggressive local intervention. The purpose of this review is to describe and compare the range of non-surgical local treatment options available for the treatment of oligometastatic colorectal disease involving the liver. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - June 28, 2015 Category: Cancer & Oncology Source Type: research
DRO1/CCDC80 : a Novel Tumor Suppressor of Colorectal Carcinogenesis
Abstract
Dro1/Ccdc80 has been identified as a tumor suppressor gene in colorectal, thyroid, and ovarian cancer. Dro1/Ccdc80 is ubiquitously expressed and has, next to its tumor suppressive role, been implicated in a wide range of biological processes, including adipogenesis, lens development, and skeletogenesis. DRO1/CCDC80 is a secreted protein that assembles with the extracellular matrix and promotes cell adhesion. The biological mechanisms by which DRO1/CCDC80 exerts its various functions are still widely unknown. DRO1/CCDC80 inhibits malignant growth properties of cancer cells, me...
Source: Current Colorectal Cancer Reports - June 18, 2015 Category: Cancer & Oncology Source Type: research
Diabetes Mellitus and Colorectal Cancer Risk
Abstract
Colorectal cancer is the third most common cancer, after lung/bronchus, breast, or prostate cancer. The association between diabetes and cancer has been reported in many cohorts, with an association described in both colon cancer and rectal cancer, in both genders. Duration could be a determinant factor of the risk. The relationship between diabetes and colorectal cancer could be directly due to hyperglycemia or indirectly via hyperinsulinemia or elevated levels of IGF-1, even more as both diseases share common risk factors such as obesity. Antidiabetic treatments should be taken in account; trea...
Source: Current Colorectal Cancer Reports - June 12, 2015 Category: Cancer & Oncology Source Type: research
Genetic Landscape of Primary Versus Metastatic Colorectal Cancer: to What Extent Are They Concordant?
Abstract
Recent developments in genomic technologies have led an unprecedented view of the profound molecular complexity of colorectal cancer (CRC) and its evolution. The genomic landscape of CRC is characterized by a high heterogeneous landscape both at an intratumoral and at an inter-metastatic and intrametastatic level. In the era of personalized cancer medicine, the challenge is the definition of predictive biomarkers in respect of a such complex scenario. Despite the robust differences occurring between primary tumor and metastatic sites, the biomarkers currently validated in clinical practice have h...
Source: Current Colorectal Cancer Reports - June 12, 2015 Category: Cancer & Oncology Source Type: research
Hepatic Arterial Infusion Pump Chemotherapy for Colorectal Liver Metastases: Making a Comeback?
Abstract
Nearly half of patients diagnosed with colorectal cancer will develop metastases during their lifetime; the majority of them were found within the liver. Surgical resection of liver metastases is the only curative therapy with 5-year survival rates ranging from 40 to 58 %. Unfortunately, less than 25 % of patients are eligible for resection. Before the advent of the modern systemic chemotherapy era, the administration of hepatic artery infusion (HAI) chemotherapy was widespread in the treatment of colorectal liver metastasis (CLM). However, due to a lack of demonstrated increased survival follo...
Source: Current Colorectal Cancer Reports - June 11, 2015 Category: Cancer & Oncology Source Type: research
