Metastatic_Colorectal_Cancer_NCCN2025.pptx

Locally Advance Colorectal CAncer management

1. Metastatic Colorectal Cancer: NCCN 2025-Based Management Presenter: Dr [Your Name] Affiliation: [Institution Name] Date: [Month 2025] Reference: —

2. Global Epidemiology & Burden • CRC = 3rd most common, 2nd leading cause of cancer death • ~1.9M new cases, >900k deaths (GLOBOCAN 2024) • 20–25% present metastatic; 35–40% recur after surgery Ref: NCCN Colon Cancer v3.2025

3. Natural History and Pathophysiology • Median OS untreated: ~6 months • Modern therapy: median OS >30 months • 5-year survival: ~15% overall, >40% if liver mets resected Ref: NCCN 2025

4. Common Metastatic Patterns • Liver (70%), Lung (20%), Peritoneum (10%) • Bone/brain less frequent • Imaging patterns influence management Ref: NCCN 2025

5. Prognostic Factors • Performance status (ECOG 0–2) • Tumor burden & sites of metastasis • Molecular profile (RAS/BRAF/MSI) • CEA baseline Ref: NCCN 2025

6. Diagnostic Workup and Staging • CT CAP ± MRI liver; PET if surgical candidate • Labs: CBC, LFT, RFT, CEA • Confirm adenocarcinoma • MDT review recommended Ref: NCCN 2025

7. Molecular Profiling • RAS (KRAS/NRAS) → anti-EGFR resistance • BRAF V600E → poor prognosis • MSI-H/dMMR → immunotherapy responsive • HER2/NTRK → targeted therapy Ref: NCCN 2025

8. Biomarker Testing Flowchart Visual placeholder: RAS → BRAF → MSI → HER2 → NTRK pathway Ref: NCCN 2025 Illustrative Visual Placeholder

9. Multidisciplinary Tumor Board • Review all cases before therapy • Surgical, medical oncology, radiology, pathology input • Personalized therapy selection Ref: NCCN 2025

10. Treatment Goals • Curative: oligometastatic resectable • Palliative: prolong survival, symptom control • Tailor to PS, comorbidity, molecular status Ref: NCCN 2025

11. First-Line Therapy Options • FOLFOX ± Bevacizumab • FOLFIRI ± Bevacizumab • FOLFOXIRI ± Bevacizumab • CAPEOX ± Bevacizumab Ref: NCCN 2025

12. Targeted Therapy Integration • EGFR inhibitors: Cetuximab, Panitumumab (RAS/BRAF-wild, left-sided) • BRAF V600E: Encorafenib + Cetuximab • HER2+: Trastuzumab + Pertuzumab Ref: NCCN 2025

13. Immunotherapy in MSI-H/dMMR • Pembrolizumab 1L • Nivolumab ± Ipilimumab 2L+ Ref: NCCN 2025

14. First-Line Treatment Algorithm Visual placeholder: Flowchart for chemo + biologic choice based on biomarkers Ref: NCCN 2025 Illustrative Visual Placeholder

15. Summary Table: Regimens & Outcomes Visual placeholder: Table with FOLFOX, FOLFIRI, FOLFOXIRI, CAPEOX, + targeted combos Include response rate and OS Ref: NCCN 2025 Illustrative Visual Placeholder

16. Oligometastatic Disease • Liver/lung/peritoneal limited disease • Surgical resection ± ablation possible • Neoadjuvant chemo for downsizing Ref: NCCN 2025 Illustrative Visual Placeholder

17. Liver-Directed Therapies • Resection, RFA, TACE, SBRT • Curative intent in selected patients Ref: NCCN 2025

18. Pulmonary and Peritoneal Metastases • Wedge resection for lung mets • CRS ± HIPEC for peritoneal disease (select cases) Ref: NCCN 2025

19. Second-Line and Beyond • Switch chemo backbone: FOLFOX ↔ FOLFIRI • Targeted therapy per molecular profile • Regorafenib, TAS-102, Fruquintinib Ref: NCCN 2025

20. Emerging Therapies • KRAS G12C inhibitors + EGFR • ADCs, novel immunotherapy • Clinical trial enrollment encouraged Ref: NCCN 2025

21. Response Assessment & Monitoring • Imaging every 8–12 weeks • CEA trends • RECIST 1.1 criteria • Monitor toxicity (neuropathy, diarrhea, HTN) Ref: NCCN 2025

22. Toxicity Management & Supportive Care • Dose modification for neuropathy/diarrhea • Manage hypertension, proteinuria • Nutrition, psychosocial support Ref: NCCN 2025

23. Palliative Care Integration • Early integration improves QoL and survival • Symptom management: pain, obstruction, stoma care Ref: NCCN 2025

24. Key Takeaways & Treatment Algorithm Visual placeholder: Summary infographic of NCCN 2025 treatment sequencing Ref: NCCN 2025