Treating Resectable Metastatic Colorectal Cancer

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The management of resectable metastatic colorectal cancer (CRC) comes with many challenges, due to an overall lack of sufficient data. Claus-Henning Köhne, MD, PhD, believes that treatment decisions are best handled in a multidisciplinary environment. In general, he notes, treatment can be based on the number of metastatic lesions and should include the administration of chemotherapy.

Axel Grothey, MD, believes the treatment approach taken relies heavily on the time point and context at presentation. As an example, he notes that if a patient presents with stage IV colon cancer and liver metastasis then chemotherapy is essential. However, if the metastasis appears several years after the initial presentation, a more conservative treatment approach may be effective. In both cases, Grothey believes that chemotherapy should be administered to treat unseen micrometastasis, even in the context of an easily resectable liver metastasis.

Heinz-Josef Lenz, MD, notes that unlike other cancer types, metastatic CRC is curable. In general, he adds, CRC develops differently than other cancer types making its treatment paradigm unique. As a result, Lenz believes, if a patient is responding to FOLFIRI and a targeted agent it is acceptable to use this regimen in both the neoadjuvant and adjuvant space.

In the adjuvant setting, Johanna Bendell, MD, recommends treatment with chemotherapy plus bevacizumab for 6 months. Moderator, John L. Marshall, MD, notes that in other types of cancer adjuvant therapy may be continued for up to 10 years. However, this type of approach has not been accepted in CRC due to an overall lack of supporting data.

Following adjuvant treatment, these patients should be followed using a variety of approaches, such as CT scan, physical exams, and CEA. Overall, the aggressiveness of this surveillance varies based on the patient and physician.