Abstract
Colorectal cancer (CRC) is the second cause of cancer death in Spain, the objective of this guide published by the Spanish Society of Medical Oncology is to develop a consensus for the diagnosis and management of metastatic disease. The optimal treatment strategy for patients with metastatic CRC should be discussed in a multidisciplinary expert team to select the most appropriate treatment, and integrate systemic treatment and other options such as surgery and ablative techniques depending on the characteristics of the tumour, the patient and the location of the disease and metastases.
Highlights
In Spain, 41,441 new cases of Colorectal cancer (CRC) were estimated for 2015, representing the second most common tumour type in both sexes
Preliminary data suggest that high-microsatellite instability (MSI-H) or mismatch repair deficient and HER-2 over-expression or amplification, might have a role as predictive factors for therapy with check-point inhibitor antibodies and trastuzumab plus lapatinib, respectively, but at the moment only check-point inhibitors are approved by the FDA, but not for the European Medicines Agency (EMA) as immunotherapy for resistant MSI-H/dMMR colorectal cancer patients
The analysis showed a benefit of chemotherapy in PFS and DFS but not in OS
Summary
In Spain, 41,441 new cases of CRC were estimated for 2015, representing the second most common tumour type in both sexes. All the studies that have validated the role of RAS mutations as negative predictive factor for anti-EGFR therapy were done with available archived paraffin tumour samples and should be kept as the gold-standard in clinical practice as long as the performing lab complies with nationally and internationally qualified quality assurance programs. Preliminary data suggest that high-microsatellite instability (MSI-H) or mismatch repair deficient (dMMR) and HER-2 over-expression or amplification, might have a role as predictive factors for therapy with check-point inhibitor antibodies and trastuzumab plus lapatinib, respectively, but at the moment only check-point inhibitors are approved by the FDA, but not for the EMA as immunotherapy for resistant MSI-H/dMMR colorectal cancer patients. Mismatch repair deficiency (IHC or MSI-H) is recommended to find patients potential candidates for immunotherapy rescue
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