Abstract
Liver metastases are the most common site of metastatic spread in colorectal cancer. Current treatment approaches involve effective systemic therapies in combination with surgical and/or interventional strategies. Multimodal strategies greatly improved clinical outcomes of patients with metastatic colorectal cancer over the last decades. Identification of predictive and prognostic biomarkers helped to comprehensively refine individual targeted treatment approaches and resulted in median overall survival rates of 30 months or longer. Current guidelines, thus, recommend treatment selection according to patients’ performance status, tumor localization and stage as well as the tumor’s molecular and genetic status. Here, we outline the latest developments in molecular decision-making for patients with upfront resectable, potentially or initially unresectable and non/never-resectable colorectal cancer liver metastases.
Highlights
The significant improvement in overall survival in patients with mCRC is based on an increasing number of patients that are treated in specialist cancer centers by multidisciplinary teams
First-line regimens are generally combined with targeted approaches including monoclonal antibodies directed towards vascular endothelial growth factor (VEGF), i.e., bevacizumab, or towards the epidermal growth factor receptor (EGFR) with panitumumab and cetuximab
The benefit of perioperative or additive chemotherapy could not be confirmed in patients with favorable prognostic factors and clearly resectable colorectal liver metastases (CLM), regardless of underlying mutational status
Summary
Clinical outcomes of patients with metastatic disease (mCRC) have improved significantly over the last decades due to identification of prognostic and predictive molecular biomarkers and subsequent individual refinement of treatment strategies [4,5]. Application of multimodal treatment approaches, including effective and biomarker-based systemic therapies as well as resection and local ablation of metastases, is considered standard of care for therapy of mCRC [5]. Therapeutic decision-making for patients with mCRC is mainly based on (i) patients’ performance status (PS), (ii) the extent and localization of disease and (iii) molecular profiles [6,7]. This review outlines key aspects of decision-making for patients with colorectal liver metastases (CLM), focusing on predictive and prognostic molecular biomarkers. CLM (i.e., ESMO group 2 and 3) [6]
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