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CC BY-NC-ND 4.0 · South Asian J Cancer 2024; 13(04): 287-295
DOI: 10.1055/s-0044-1791689
Original Article
Chemotherapy

Management of Metastatic Colorectal Cancer (mCRC): Real-World Recommendations

Purvish M. Parikh
1   Department of Clinical Hematology, Sri Ram Cancer Center, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
,
Ankur Bahl
2   Department of Medical Oncology, Fortis Hospital, Gurugram, Haryana, India
,
Gopal Sharma
3   Department of Medical Oncology, Max Healthcare Hospital, New Delhi, India
,
Raja Pramanik
4   Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
,
Jyoti Wadhwa
5   Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Peush Bajpai
6   Department of Medical Oncology, Manipal Hospital, New Delhi, India
,
Sunny Jandyal
7   Department of Medical Oncology, Action Cancer Hospital, New Delhi, India
,
A P. Dubey
8   Department of Medical Oncology, Delhi Heart and Lung Institute, New Delhi, India
,
Aditya Sarin
9   Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
,
Subash Chandra Dadhich
10   Department of Laparoscopic Surgery, Arogya Hospital, Vizag, Andhra Pradesh, India
,
Avinash P. Saklani
11   Department of Surgical Gastroenterology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Ashok Kumar
12   Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
,
Abhijit Chandra
13   Department of Surgical Gastroenterology, King George Medical University, Lucknow, Uttar Pradesh, India
,
Saumitra Rawat
14   Department of Surgical Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
,
C. Selvasekar
15   Clinical Services and Specialist Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom
,
Shyam Aggarwal
16   Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
› Author Affiliations
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Abstract

Introduction

Metastatic CRC is considered as a heterogenous disease. Its management is therefore complex and dynamic. In order the give a ready reference to community oncologists, we developed this real world recommendations.

Methods

A group of experts with academic background and real world experience in mCRC got together. We reviewed the current literature and the insights gained from our real world experience. Based on the same we put together these recommendations.

Recommendations (Results)

Molecular testing should be done wherever possible. Most of these patients will be treated with a palliative approach. Doublet chemotherapy is a long-standing standard of care. Triplet therapy may be offered where a more aggressive approach is indicated. Combination with anti -vascular endothelial growth factor antibodies and/or anti EGFR antibodies is also considered standard. In the first-line setting, pembrolizumab can be used for patients with mCRC and microsatellite instability-high or deficient mismatch repair tumours; Left and right sided tumours are distinct entities. Combination of chemotherapy and targeted therapy is used as per individual patient and tumour characteristics.

Oligometastatic disease can be approached with potentially curative intent. Cytoreductive surgery plus chemotherapy can be offered to selected patients with peritoneal only metastases. Stereotactic body radiation therapy can be used as local therapy for patients with oligometastatic liver only disease who cannot be taken up for surgery. New strategies include induction-maintenance chemotherapy and perioperative chemotherapy. All drugs/ regimen included as standard of care in the first line can also be used in subsequent lines. Specific targetable driver mutation tumours can be treated accordingly with their complementary biological therapy.

Conclusion

Multidisciplinary team management and shared decision making are possible when patient and caregivers choose to become active participants.

Keywords

aggressive cancer - overall survival - personalized oncology - systemic therapy


Publication History

Article published online:
11 December 2024

© 2024. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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