Looking back 2018--focused on colorectal cancer

Abstract

Colorectal cancer is one of the most common malignant tumors, and its incidence and mortality are increasing year by year in China. In 2018, for the first time, the FIT-DNA test was written into the expert consensus as the recommended screening technology in China. As the core technology of colorectal cancer screening, colonoscopy for right colon cancer is further supported. With the application of artificial intelligence technology in colonoscopy, the efficiency and accuracy of screening will be greatly improved. New screening technologies represented by circulating tumor cell (CTC) and individualized screening programs based on molecular genetics are future directions. As the core of colorectal cancer treatment, surgery has become quite mature. Traditional laparoscopic surgery has become an optimal choice for colorectal cancer surgery. Open surgery, robotic surgery and single-incision laparoscopic surgery have not been found superior to multiport laparoscopic surgery. The focus of surgical research is to precisely select surgical methods, and to protect normal physiological function of patients. For example, in order to reduce complications and improve quality of life in patients undergoing rectal cancer surgery after neoadjuvant radiotherapy, the "Tianhe surgery" was invented by the authors' team. Chemotherapy as the basis of colorectal cancer treatment has shown good results in many aspects: The PRODIGE-7 trial has confirmed that systemic chemotherapy is more important for colorectal peritoneal metastasis after high quality cytoreductive surgery (CRS). While the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin does not result in the better overall survival (OS), but increases the risk of postoperative complications. The FOWARC study has found that the FOLFOX regimen (oxaliplatin and fluorouracil) achieved a 3-year disease-free survival (DFS) rate similar to that of neoadjuvant chemoradiotherapy, challenging the clinical value of radiotherapy. Although several studies have confirmed that total neoadjuvant therapy (TNT) can improve pathological complete response (pCR) rate and DFS of patients with colorectal cancer, we do not recommend unretricted expansion of chemotherapy. How to combine the clinical characteristics and molecular biological markers to select high-risk groups for chemotherapy, and how to use personalized medicine according to the genetic characteristics of patients, are also hot spots of current research. Immunotherapy is a game-changer in all aspects of colorectal cancer. In order to adapt to the immune therapy, the efficacy evaluation standard of solid tumors (iRECIST) has been revised. Immune score could redefine tumor clinical staging system. Both the Checkmate-142 study for advanced tumors and the NCT03026140 study on neoadjuvant treatment for early tumors showed promising results. Although no significant progress has been seen in the EGFR-targeted therapy and VEGFR-targeted therapy, new targeted drugs such as Eltanexor (ETLA, kpt -8602) and cobimetinib (MEK inhibitor) have been found to be effective in clinical studies. According to the detection results of tumor-related signaling pathways in patients, cross-guidance selection of targeted drug therapy is also the direction of research. Although the IWWD research results give a big blow to the "watch and wait" strategy, with the exploration of TNT plan, more accurate imaging efficacy evaluation and the application of immunotherapy, the "watch and wait" strategy will also receive new attention. In recent years, we have seen the rapid development of artificial intelligence technology. Although it is still in the exploratory stage in the field of medicine, it will certainly reshape all aspects of colorectal cancer diagnosis and treatment in the future, leading the research direction.