Ejaz A., Pawlik T.M. (eds.) Contemporary Management of Metastatic Colorectal Cancer: A Precision Medicine Approach

New York: Academic Press, 2022. — 331 p.Contemporary Management of Metastatic Colorectal Cancer: A Precision Medicine Approach summarizes current knowledge and provides evidenced-based practice recommendations on how to treat patients with metastatic colorectal cancer. The book presents topics such as pre-operating imaging, the use of molecular markers in treatment decisions, neoadjuvant therapy, synchronous colorectal liver metastasis, and minimally invasive approaches. In addition, it discusses immunotherapy, targeted therapies and survivorship. This is a valuable resource for practitioners, cancer researchers, oncologists, graduate students and members of biomedical research who need to understand more about novel treatments for colorectal cancer metastasis.Epidemiology and risk factors for metastatic colorectal disease.
Colorectal cancer incidence and survival.
Risk factors for colorectal cancer.
Screening guidelines.The tumor microenvironment of colorectal cancer liver metastases: Molecular mediators and future therapeutic targets.The unique immune microenvironment of the liver.
Role of liver sinusoidal endothelial cells.
The natural killer cells of the liver.
Liver dendritic cell functions.
Neutrophils opposing roles in liver metastasis progression.
Myeloid-derived suppressor cells \(MDSCs\) promote liver metasasis by diverse mechanisms.
Role of hepatic stellate cells.
Multiple factors combine to inhibit a cytolytic T cell response to metastatic cancer cells.
The extracellular matrix regulates cancer cell survival and growth in the liver.
The unique extracellular matric \(ECM\) of the liver and liver metastases.
The ECM and cell adhesion molecules.
The effect of ECM stiffness.
Potential strategies for targeting the microenvironment of CRLM and increasing immunotherapy efficacy in patients.Chapter 3 Pre-operative imaging, response evaluation, and surgical planning ^^e2^^80^^93 CT, PET, radiomics, and FLR measurement.Role of imaging in CRLM.
Pre-operative imaging of CRLMs.
Initial staging.
Ultrasonography \(US\).
Computed tomagraphy \(CT\).
Magnetic resonance imaging \(MRI\).
Fluorodeoxyglucose-positron emission tomography \(FDG-PET\).
Assessment of prognosis and surgical candidacy.
Use of imaging for surgical planning.
Pre-operative treatment and response evaluation of CRLM.
Downsizing of initially unresectable lesions.
Increasing future remnant liver volume and volumetric assessment.
Volumetric assessment.
Increasing future remnant liver volume.
Alternative therapies for CRLM.
Ablation.
Hepatic artery infusion \(HAI\) and selective internal radiation therapy \(SIRT\).Use of molecular markers and other personalized factors in treatment decisions for metastatic colorectal cancer.Prognostic versus predictive.
Disease characteristics.
Histology.
Pharmacogenetics for conventional cytotoxic chemotherapy.
KRAS.
BRAF.
HER2.
DNA microsatellite instability and immunotherapy.
Tumor sidedness.
Circulating tumor cells and cell free DNA.
Gut microbiome.Role of Neoadjuvant therapy in the treatment of patients with colorectal liver metastases.Rationale for perioperative chemotherapy for colorectal liver metastases.
Preoperative chemotherapy for patients with unresectable liver metastases.
Neoadjuvant chemotherapy for resectable liver metastases.
Safety of neoadjuvant chemotherapy for colorectal liver metastases.Management of the disappeared colorectal liver metastasis.Defining disappearing colorectal liver metastasis \(DLM\).
Predictors of DLM pathologic response.
Intra-Operative evaluation of DLM.
Surgical resection versus surveillance of DLM.Approach to small liver remnant ^^e2^^80^^93 strategies to increase resectability.Future liver remnant \(FLR\).
Calculating FLR.
Optimal future liver volume.
Portal vein embolization \(PVE\).
Indications and contraindications for PVE.
Portal vein ligation, a historical perspective.
Technical aspects of PVE.
Post-PVE hypertrophy/kinetic growth rate.
Combined portal vein & hepatic vein embolization.
Associating liver partition and portal vein ligation.Two-stage versus ALPPS for the large intrahepatic burden of colorectal liver metastasis.
FLR hypertrophy and feasibility to complete both stages.
Morbidity and Mortality.
Oncological results.Synchronous colorectal liver metastasis ^^e2^^80^^93 simultaneous vs. staged approach.Sequencing of care for sCRLM.
Perioperative chemotherapy.
Simultaneous approach.
Staged approaches: primary-first.
Staged approaches: liver-first.
Surgical approach summary.
MSK approach.
Case-based learning.Minimally invasive approaches to colorectal liver metastases.Laparoscopic liver resection.Outcomes.
Robotic liver resection.Outcomes.
Laparoscopic radiofrequency ablation.Outcomes.
Laparoscopic microwave coagulation.Outcomes.Hepatic resection of colorectal liver metastasis in the presence of extrahepatic disease.
Incidence of extrahepatic disease.
Diagnosis of extrahepatic disease.
Role of surgery in patients with extrahepatic disease.
Recurrence.
Lung metastases.
Lymph node metastases.
Peritoneal metastases.Locoregional approaches to colorectal liver metastasis ^^e2^^80^^93 ablation.Indications and contraindications.
Radiofrequency vs microwave ablations.
Ablation approaches.
Post-ablation complications.
Surveillance.
Local recurrence rates.
Long-term outcomes.
Long-term outcomes of the multi-modality treatments.
Summary points.
Disclosure statement.Locoregional approaches to colorectal liver metastasis ^^e2^^80^^93 intra-arterial.Embolic therapies.
Indications and outcomes.
Summary of embolic therapies.
Transarterial radioembolization \(TARE\).
Hepatic artery infusion chemotherapy \(HAIC\).
HAIP: function and insertion.
Indications, contraindications, and other complications.
Summary of hepatic arterial infusion chemotherapy.
HAIC outcomes relative to other intra-arterial therapies.Case stems.Locoregional Approaches to Colorectal Liver Metastasis ^^e2^^80^^93 Radiation Options.
Introduction: external beam radiation therapy \(EBRT\) for colorectal liver metastases.
External beam radiation: rationale for ablative dosing.
External beam radiation: patient selection.
External beam radiation: treatment planning considerations.
External beam radiation: target volume design and treatment objectives.
External beam radiation: outcomes and surveillance considerations.
Future directions.Immunotherapy and targeted therapies for colorectal liver metastasis.
Targeted therapy in CRC with CLM.
Resectable CLM at diagnosis with no extra-hepatic metastatic disease.
Unresectable CLM at diagnosis with potential for resection with no extra-hepatic metastatic disease.
CLM with no potential for resection and/or unresectable extra-hepatic disease.
First-line therapy- in combination with chemotherapy.
Subsequent lines of therapy.
Immunotherapy.Adjuvant therapy following resection of colorectal liver metastases.Timing of systemic treatment.
Role of adjuvant treatment.
Adjuvant intra-arterial chemotherapy following resection of colorectal liver metastases.Clinical case.Long-term prognosis and surveillance of patients with resected colorectal liver metastasis.Clinical risk scores.
Other prognostic tools.
Inflammatory and immune predictors of survival.
Predicting recurrence.
Surveillance and recurrence.Management of secondary recurrence of intra-hepatic colorectal liver metastasis following initial hepatic resection.Surveillance following initial hepatectomy.
Frequency of testing.
Length of surveillance.
Testing parameters.
Repeat liver resection.
Technical considerations.
Published experience with repeat hepatectomy.
Early recurrence.
Other treatment modalities.
Systemic therapy.
Ablation therapy.
Ablative radiation.
Transarterial chemoembolization \(TACE\).
Transarterial radioembolization \(TARE\).
Hepatic artery infusion chemotherapy \(HAIC\).
Transplant.Colorectal liver metastasis: survivorship.What is a cancer survivor?
Colorectal cancer survivors with liver metastases.
Surveillance for recurrence and screening for second primary cancers.
Prognosis.
Disparities in metastatic colorectal cancer survival.
Surveillance and screening.
Assessment and management of physical and psychosocial effects of colorectal cancer and treatment.
Methods of assessment.
Post-Diagnosis pain.
Fatigue and physical activity.
Mood/Mental health/depression/fear.
Bowel function.
Ostomy-Specific concerns.
Sexual wellness.
Financial burden.
Specific HRQoL outcomes in patients with colorectal cancer liver metastases.
Routine health promotion needs.
Coordination of care among specialists and primary care clinicians.
Experience with healthcare providers.
Progressive disease.
Palliative care involvement.
Limitations and future directions.
Surveillance for recurrence and screening for second primary cancers.
Assessment and management of physical and psychosocial effects of colorectal cancer and treatment.
Coordination of care among specialists and primary care clinicians.