DOI: http://dx.doi.org/10.18203/2349-3933.ijam20214146

Indian consensus statement on the management of metastatic colorectal cancer

Ashok K. Vaid, Prabrajya N. Mohapatra, Chirag Desai

Abstract


In India, the annual incidence rates for colon cancer are 4.4 (males) and 3.9 (females) per 100,000. A common guideline for the management of metastatic colorectal cancer (mCRC) in the Indian subcontinent is lacking. Four virtual advisory board meetings consisting of a panel of 31 experts were conducted to discuss and arrive at a consensus on the treatment patterns and clinical evidence on the management of mCRC in Indian patients. The consensus covered the entirety of treatment patterns suited for the Indian subcontinent and its alignment with Pan-Asian adapted European Society for Medical Oncology guidelines. Recommendations were provided for choosing the first- and second-line agents for treatment. Types of, recommendations for, and management using salvage therapy and immunotherapy as well as management of adverse effects were discussed. Thus, the mCRC consensus is expected to serve as effective and readily available guidance for practicing oncologists across India.


Keywords


Salvage therapy, Treatment patterns, Colorectal cancer

Full Text:

PDF

References


ICMR. Consensus document for management of colorectal cancer. Available at https://main.icmr. nic.in/sites/default/files/guidelines/Colorectal%20Cancer_0.pdf. Accessed 9 April 2021.

Dattatreya S. Metastatic colorectal cancer-prolonging overall survival with targeted therapies. South Asian J Cancer. 2013;2(3):179-85.

Colorectal cancer: Diagnosis. Available at https://www.cancer.net/cancer-types/colorectal-cancer/diagnosis. Accessed 9 April 2021.

Colorectal cancer: Risk Factors and Prevention. Available at https://www.cancer.net/cancer-types/colorectal-cancer/risk-factors-and-prevention. Accessed 9 April 2021.

Parmar A, Chan KKW, Ko YJ. Metastatic colorectal cancer: therapeutic options for treating refractory disease. Curr. Oncol. 2019;26(1):S24-S32.

Wild-type KRAS gene. Available at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/wild-type-kras-gene. Accessed 9 April 2021.

Shrikhande SV, deSouza A. Problem of colorectal cancer in India and issues related to management. Apollo Medicine. 2015;12(3):190-3.

Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394:1467-80.

Neugut AI, Prigerson HG. Curative, Life‐Extending, and Palliative Chemotherapy: New Outcomes Need New Names. The Oncologist. 2017;22(8):883-5.

Sacerdote C, Baldi I, Bertetto O, DiCuonzo D, Farina E, Pagano E, et al. Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study. BMC Public Health. 2012;12:1-10.

Shields AF. What is the Optimal Duration of Adjuvant Therapy in Colon Cancer? Clinical Advances in Hematology & Oncology. 2017;15(10):734-8.

Zhou Z, Nimeiri HS, Benson III AB. Preoperative chemotherapy for locally advanced resectable colon cancer-a new treatment paradigm in colon cancer? Ann. Transl. Med. 2013;1(2):1-5.

Bjerkeset T, Morild I, Mørk S, Søreide O. Tumor characteristics in colorectal cancer and their relationship to treatment and prognosis. Dis. Colon. Rectum. 1987;30:934-8.

Vacante M, Borzì AM, Basile F, Biondi A. Biomarkers in colorectal cancer: Current clinical utility and future perspectives. World. J. Clin. Cases. 2018;6(15):869-81.

Van Cutsem E, Kohne CH, Láng I, Folprecht G, Nowacki MP, Cascinu S, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J. Clin. Oncol. 2011;29(15):1-10.

Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, Yamazaki K, Xu RH, et al. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO–ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Annals of Oncology. 2018;29(1):44-70.

Lee JJ, Sun W. Options for Second-line Treatment in Metastatic Colorectal Cancer. Clin. Adv. Hematol. Oncol. 2016;14(1):46-54.

Lam M, Lum C, Latham S, Smith ST, Prenen H, Segelov E. Refractory Metastatic Colorectal Cancer: Current Challenges and Future Prospects. Cancer Management and Research. 2020;12:5819-30.

Price TJ, Peeters M, Kim TW, Li J, Cascinu S, Ruff P, et al. Panitumumab versus cetuximab in patients with chemotherapy-refractory wild-type KRAS exon 2 metastatic colorectal cancer (ASPECCT): a randomised, multicentre, open-label, non-inferiority phase 3 study. Lancet. Oncol. 2014;15(6):569-79.

Switch to maintenance therapy ‘appropriate and beneficial’ in metastatic colorectal cancer. Available at https://www.healio.com/news/hematology-oncology/20191219/switch-to-maintenance-therapy-appropriate-and-beneficial-in-metastatic-colorectal-cancer#:~:text=Maintenance%20chemotherapy%20following%20initial%20treatment,trials%20published%20in%20JAMA%20Oncology. Accessed 9 April 2021.

Marshall JL. Maintenance Therapy in Metastatic Colorectal Cancer. Clinical Advances in Hematology & Oncology. 2014;12(6):388-90.

Koopman M, Simkens L, May AM, Mol L, van Tinteren H, Punt CJA, et al. Final results and subgroup analyses of the phase 3 CAIRO3 study. Available at https://ascopubs.org/doi/abs/ 10.1200/jco.2014.32.15_suppl.3504. Accessed 9 April 2021.

Brule SY, Jonker DJ, Karapetis CS, O’Callaghan CJ, Moore MJ, Wong R, et al. Location of colon cancer (right-sided versus left-sided) as a prognostic factor and a predictor of benefit from cetuximab in NCIC CO. 17. European Journal of Cancer. 2015;51(11):1405-14.

Helwick C. ‘Sidedness’ in Colon Cancer: Using the Data in the Clinic. Available at https://ascopost.com/issues/september-10-2017/sidedness-in-colon-cancer-using-the-data-in-the-clinic/. Accessed 9 April 2021.

Tejpar S, Stintzing S, Ciardiello F, Tabernero J, Van Cutsem E, Beier F, et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA. Oncol. 2017;3(2):194-201.

Osawa H. Response to regorafenib at an initial dose of 120 mg as salvage therapy for metastatic colorectal cancer. Mol. Clin. Oncol. 2017;6(3):365-72.

Damilakis E, Mavroudis D, Sfakianaki M, Souglakos J. Immunotherapy in Metastatic Colorectal Cancer: Could the Latest Developments Hold the Key to Improving Patient Survival? Cancers. 2020;12(4):889.

Slater H. Phase III KEYNOTE-177 Study of Pembrolizumab Doubles PFS in MSI-H/Dmmr mCRC. Available at https://www.cancernetwork. com/view/phase-iii-keynote-177-study-pembrolizumab-doubles-pfs-msi-hdmmr-mcrc. Accessed 9 April 2021.

Argiles G, Arnold D, Prager G, Sobrero AF, Van Cutsem E. Maximising clinical benefit with adequate patient management beyond the second line in mCRC. ESMO open. 2019; 4:e000495.

Hurwitz H, Saini S. Bevacizumab in the treatment of metastatic colorectal cancer: safety profile and management of adverse events. Semin. Oncol. 2006;33:S26-S34.

Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, et al. Interventional tools to improve medication adherence: review of literature. Patient Preference and Adherence. 2015;9:1303-14.