TY  - CHAP
M1  - Book, Section
TI  - Colorectal Cancer
A1  - Dasari, Arvind
A1  - Johnson, Benny
A1  - Parseghian, Christine
A1  - Raghav, Kanwal P.
A1  - Kopetz, Scott
A2  - Kantarjian, Hagop M.
A2  - Wolff, Robert A.
A2  - Rieber, Alyssa G.
PY  - 2022
T2  - The MD Anderson Manual of Medical Oncology, 4e
AB  - KEY  CONCEPTSAlthough  the  overall  incidence  of  incidence  of  colorectal  cancer  (CRC)  has  decreased,  its  incidence  in  those  younger  than  50  years  of  age  (ie,  early-onset  CRC)  has  significantly  increased  over  the  past  2  to  3  decades,  accounting  for  an  estimated  one  of  every  10  cases  currently  being  diagnosed  in  the  United  States.Surgery  is  the  cornerstone  of  curative  therapy  in  locoregional  CRC.  Adjuvant  chemotherapy  with  a  fluoropyrimidine  typically  in  combination  with  oxaliplatin  is  standard-of-care  adjuvant  therapy  for  patients  with  stage  III  and  IV  and  high-risk  stage  II  colon  cancer.  Recent  data  support  tailoring  duration  of  therapy  (3  months  vs  6  months)  based  on  pathologic  stage  for  stage  III  colon  cancer.In  patients  with  locally  advanced  rectal  adenocarcinoma,  the  paradigm  has  shifted  to  a  total  neoadjuvant  therapy  approach  in  which  systemic  chemotherapy  in  addition  to  neoadjuvant  radiation  is  administered  before  surgery.  Ongoing  studies  are  evaluating  deintensifying  such  trimodality  therapy  by  omitting  surgery  or  radiation  in  select  patients.Biomarker  testing  that  includes  mismatch  repair  deficiency  should  be  performed  in  all  patients  with  CRC;  expanded  RAS  (KRAS  and  NRAS  exons  2,3,  4),  BRAFV600E  mutation,  and  HER2neu  amplification  should  be  performed  in  all  patients  with  metastatic  CRC.  NTRK  fusion  and  POLE  mutations  are  rare  but  targetable  aberrations  in  metastatic  CRC  (mCRC).  All  patients  with  mCRC  should  be  evaluated  for  resectable  disease  at  diagnosis  and  at  each  restaging.Most  patients  with  mCRC  are  treated  with  fluoropyrimidine-based  combination  chemotherapy  with  oxaliplatin,  irinotecan,  or  both  in  the  first-  and  second-line  settings.  Monoclonal  antibodies  (mAbs)  against  the  vascular  endothelial  growth  factor  axis  or  epidermal  growth  factor  receptor  (EGFR)  may  be  used  in  combination  with  such  chemotherapy.  The  use  of  anti-EGFR  antibodies  should  be  limited  to  RAS  wild-type  patients  and  to  those  with  tumors  arising  in  the  left  colon  at  least  in  the  first-line  setting.  Patients  with  incurable  metastatic  disease  should  be  considered  for  periods  of  less  intensive  therapy  during  their  treatment  course  as  the  clinical  situation  warrants.  Patients  with  mismatch  repair–deficient  mCRC  are  responsive  to  immunotherapy  and  should  be  treated  with  such  agents,  including  in  the  first-line  setting.A  biologic  doublet  therapy  of  encorafenib  (BRAF  inhibitor)  in  combination  with  cetuximab  (EGFR  mAb)  is  now  standard  of  care  for  patients  with  previously  treated  BRAFV600E  mutant  mCRC.  Regorafenib  and  TAS-102  are  oral  agents  for  patients  with  refractory  disease  in  later  lines  of  therapy.  Ongoing  trials  are  evaluating  role  of  anti-Her2neu  therapy  in  patients  with  Her-2neu  amplification  and  rechallenge  with  anti-EGFR  antibodies  in  patients  with  prior  clinical  benefit  and  subsequent  progression.  
SN  - 
PB  - McGraw Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1190835881
ER  -