Metastatic_Colorectal_Cancer_Management.pptx

How to treat locally advance colorectal cancer

1. Metastatic Colorectal Cancer: Diagnosis and Management Presenter: Dr [Your Name] Affiliation: [Institution Name] Date: [Month Year]

2. Global Epidemiology & Burden • 3rd most common cancer, 2nd leading cause of cancer death worldwide. • 20–25% present with metastases, 30–40% develop later. • Common sites: liver (70%), lung (20%), peritoneum (10%). Ref: Sung H et al., CA Cancer J Clin 2024; GLOBOCAN 2024.

3. Definition and Staging • Stage IV = distant metastasis. • Categories: potentially resectable, unresectable, widespread. • TNM 8th Edition used for staging. Ref: AJCC 8th Edition.

4. Diagnostic Work-Up • Imaging: CT CAP ± MRI liver; PET/CT for surgical candidates. • Labs: CBC, LFT, CEA. • Pathology confirmation mandatory. • Early MDT evaluation recommended. Ref: NCCN Colon Cancer v3.2025.

5. Molecular Profiling • RAS (KRAS/NRAS) → predicts anti-EGFR response. • BRAF V600E → poor prognosis. • MSI-H/dMMR → immunotherapy responsive. • HER2, NTRK → rare but targetable. Ref: ASCO 2022; ESMO 2022.

6. Treatment Goals • Curative: oligometastatic, resectable disease. • Palliative: survival, symptom control. • Individualize based on PS, comorbidity, molecular profile. Ref: ASCO 2022.

7. First-Line Systemic Therapy • FOLFOX, FOLFIRI, CAPEOX, FOLFOXIRI. • Choice based on fitness, tumor burden. Ref: NCCN 2025; ESMO 2022.

8. Targeted Therapy Integration • Bevacizumab (anti-VEGF) with chemo. • Cetuximab/Panitumumab for RAS/BRAF-wild, left-sided. • Encorafenib + Cetuximab for BRAF V600E. • HER2+ → Trastuzumab + Pertuzumab. Ref: ASCO 2022; NCCN 2025.

9. Immunotherapy in mCRC • MSI-H/dMMR: Pembrolizumab (1st line), Nivolumab ± Ipilimumab (later line). • MSS: No benefit yet. Ref: KEYNOTE-177; NCCN v3.2025.

10. Oligometastatic Disease Management • Curative intent possible with resection. • Common sites: liver, lung. • Neoadjuvant chemo → surgery → adjuvant chemo. • RFA, SBRT, HIPEC selectively. Ref: ESMO 2022; ASCO 2022.

11. Second-Line and Beyond • Switch from FOLFOX ↔ FOLFIRI. • Regorafenib, TAS-102, Fruquintinib. • Clinical trials recommended. Ref: NCCN 2025; ASCO 2022.

12. Monitoring & Response • CT every 8–12 weeks. • CEA for trends. • Monitor toxicity (neuropathy, diarrhea, hypertension). • Response criteria: RECIST 1.1. Ref: ESMO 2022.

13. Supportive & Palliative Care • Early palliative integration improves QoL. • Manage pain, nutrition, psychosocial support. • Treat toxicities proactively. Ref: Temel J et al., NEJM 2010; NCCN 2025.

14. Emerging & Future Directions • Liquid biopsy, precision oncology. • KRAS G12C inhibitors, T-cell engagers, ADCs. • Trials exploring MSS immunotherapy combos. Ref: ESMO Open 2024; ASCO Post 2025.

15. Key Takeaways • Molecular testing essential for all. • First-line: chemo + biologic based on biomarkers. • Immunotherapy: MSI-H/dMMR. • Surgery for selected oligometastatic. • Continuous research vital. Ref: ASCO 2022; NCCN 2025.