There is clear proof of principle for adjuvant therapy in patients at high risk for tumor recurrence, such as those with resected metastatic colorectal cancer. For that reason, this strategy has been largely adopted, especially using 5-FU– and oxaliplatin-based regimens, thereby mirroring the approach in resected stage III colon cancer.
In all other settings, giving chemotherapy just to make us feel better emotionally in exchange for potential harm to the patient is not the right strategy. We need to find better treatments for this new clinical indication.
Here, we review the studies that have explored different treatment regimens, therapeutic sequencing, and biologic inclusions for the treatment of these patients, with neoadjuvant intent. We also describe how we have established our own treatment paradigm for the management of potentially curable metastatic colorectal cancer.
It remains difficult to decipher which patients are appropriate candidates for conversion therapy vs upfront surgery. Therefore, in predicting potential outcomes, several factors should be considered. Here, we will attempt to address such factors and provide insights.
In this video, Dung T. Le, MD, discusses a phase II study that found that mismatch repair–deficient colorectal tumors were highly responsive to checkpoint blockade with the anti–PD-1 drug pembrolizumab.
Blase Polite, MD, assistant professor of medicine at the University of Chicago and the track leader for the GI Colorectal Scientific Program Committee at ASCO, discusses the latest research in the field of colorectal cancer.