Contemporary Management of Metastatic Colorectal Cancer

A Precision Medicine Approach

1st Edition - June 23, 2022

Editors: Aslam Ejaz, Timothy M. Pawlik

Paperback ISBN:

9 7 8 - 0 - 3 2 3 - 9 1 7 0 6 - 3

eBook ISBN:

9 7 8 - 0 - 3 2 3 - 9 8 5 6 8 - 0

Contemporary Management of Metastatic Colorectal Cancer: A Precision Medicine Approach summarizes current knowledge and provides evidenced-based practice recommendations on how to… Read more

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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.

Cover Image
Title Page
Copyright
Dedication
Table of Contents
Contributors
Preface
Chapter 1 Epidemiology and risk factors for metastatic colorectal disease
Colorectal cancer incidence and survival
Summary
References
Chapter 2 The tumor microenvironment of colorectal cancer liver metastases: Molecular mediators and future therapeutic targets
Introduction
The unique immune microenvironment of the liver
The extracellular matrix regulates cancer cell survival and growth in the liver
Potential strategies for targeting the microenvironment of CRLM and increasing immunotherapy efficacy in patients with liver metastatic disease
Conclusion
Acknowledgements
References
Chapter 3 Pre-operative imaging, response evaluation, and surgical planning – CT, PET, radiomics, and FLR measurement
Introduction
Role of imaging in CRLM
Pre-operative imaging of CRLMs
Assessment of prognosis and surgical candidacy
Use of imaging for surgical planning
Pre-operative treatment and response evaluation of CRLM
Increasing future remnant liver volume and volumetric assessment
Alternative therapies for CRLM
Conclusion
Reference
Chapter 4 Use of molecular markers and other personalized factors in treatment decisions for metastatic colorectal cancer
Introduction
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
Conclusions
References
Chapter 5 Role of Neoadjuvant therapy in the treatment of patients with colorectal liver metastases
Introduction
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
Conclusions
References
Chapter 6 Management of the disappeared colorectal liver metastasis
Introduction
Defining disappearing colorectal liver metastasis (DLM)
Predictors of DLM pathologic response
Intra-Operative evaluation of DLM
Surgical resection versus surveillance of DLM
Summary
References
Chapter 7 Approach to small liver remnant – strategies to increase resectability
Introduction
Future liver remnant (FLR)
Portal vein embolization (PVE)
Combined portal vein & hepatic vein embolization
Associating liver partition and portal vein ligation
Conclusion
References
Chapter 8 Two-stage versus ALPPS for large intrahepatic burden of colorectal liver metastasis
FLR hypertrophy and feasibility to complete both stages
Morbidity and Mortality
Oncological results
Conclusion
References
Chapter 9 Synchronous colorectal liver metastasis – simultaneous vs. staged approach
Introduction
Sequencing of care for sCRLM
Surgical approach summary
MSK approach
Case-based learning
References
Chapter 10 Minimally invasive approaches to colorectal liver metastases
Introduction
Laparoscopic liver resection
Robotic liver resection
Laparoscopic radiofrequency ablation
Laparoscopic microwave coagulation
Conclusion
References
Chapter 11 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
Conclusions
References
Chapter 12 Locoregional approaches to colorectal liver metastasis – ablation
Introduction
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
References
Chapter 13 Locoregional approaches to colorectal liver metastasis – intra-arterial
Introduction
Embolic therapies
Transarterial radioembolization (TARE)
Hepatic artery infusion chemotherapy (HAIC)
Conclusions
Case stem
References
Chapter 14 Locoregional Approaches to Colorectal Liver Metastasis – 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
References
Chapter 15 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 a potential for resection with no extra-hepatic metastatic disease
CLM with no potential for resection and/or unresectable extra-hepatic disease
Immunotherapy
References
Chapter 16 Adjuvant therapy following resection of colorectal liver metastases
Introduction
Timing of systemic treatment
Role of adjuvant treatment
Adjuvant intra-arterial chemotherapy following resection of colorectal liver metastases
Conclusion
Clinical case
References
Chapter 17 Long-term prognosis and surveillance of patients with resected colorectal liver metastasis
Introduction
Clinical risk scores
Other prognostic tools
Inflammatory and immune predictors of survival
Predicting recurrence
Surveillance and recurrence
Conclusion
References
Chapter 18 Management of secondary recurrence of intra-hepatic colorectal liver metastasis following initial hepatic resection
Introduction
Surveillance following initial hepatectomy
Repeat liver resection
Other treatment modalities
References
Chapter 19 Colorectal liver metastasis: survivorship
Introduction
What is a cancer survivor?
Colorectal cancer survivors with liver metastases
Surveillance for recurrence and screening for second primary cancers
Assessment and management of physical and psychosocial effects of colorectal cancer and treatment
Routine health promotion needs
Coordination of care among specialists and primary care clinicians
Limitations and future directions
Summary
References
Index

Aslam Ejaz

Aslam Ejaz MD, MPH is a surgical oncologist who specializes in the treatment of pancreatic cancer, liver cancer, bile duct cancer and other gastrointestinal cancers. In addition to his clinical work, he is dedicated to teaching the future generation of surgeons and other cancer care providers as an assistant professor in the Division of Surgical Oncology at The Ohio State University. As a member of the Translational Therapeutics Program at the OSUCCC – James, one of his research interests is in the development of clinical trials to help patients receive new therapies that may not be available at other treatment centers. He is also interested in researching how patients do after surgery as well as addressing variations in perioperative surgical care and quality improvement. Dr. Ejaz’s research is dedicated to improving cancer care, and he has published over 100 peer-reviewed papers in high-impact cancer and surgical journals.

Affiliations and expertise

The Ohio State University, Wexner Medical Center, Columbus, USA

Timothy M. Pawlik

Dr. Pawlik received his undergraduate degree from Georgetown University and his medical degree from Tufts University School of Medicine. Dr. Pawlik completed surgical training at the University of Michigan Hospital and spent two years at the Massachusetts General Hospital as a surgical oncology research fellow. He then went on for advanced training in surgical oncology at The University of Texas M. D. Anderson Cancer Center in Houston. Dr. Pawlik’s main clinical interests include alimentary tract surgery, with a special interest in hepatic, pancreatic and biliary diseases. Dr. Pawlik also has an interest in medical ethics and completed a fellowship in medical ethics at the Harvard School of Public Health, as well as a Masters in Theology from Harvard Divinity School in Boston. In addition, Dr. Pawlik was the recipient of a Clinical and Translational Science Award (CTSA) KL2 Research Scholar Award and received a PhD from the Johns Hopkins Bloomberg School of Public Health in Clinical Investigations. Dr. Pawlik also received his Executive MBA Program from The Ohio State University Fisher Business School. Dr. Pawlik took his first faculty appointment at Johns Hopkins in 2005, where he was Professor of Surgery and Oncology, as well as the John L. Cameron Chair of Alimentary Tract Diseases and the Chief of the Division of Surgical Oncology until 2016. Dr. Pawlik currently is the Chair of Surgery at The Ohio State University Wexner Medical Center where he holds The Urban Meyer III and Shelley Meyer Chair for Cancer Research. Under his leadership, the Department of Surgery has recruited over 75 new faculty members, is ranked #6 for NIH funding, and has a top 10 ranked surgical residency program. Dr. Pawlik also serves as the Treasurer / Secretary of The Ohio State University Practice Plan. Dr. Pawlik has given over 575 invited talks both nationally and internationally in 35 different countries. Dr. Pawlik has published over 1,600 articles and over 100 book chapters, in addition to editing 14 surgical textbooks. His research has been cited over 72,000 times with an H-index of 128 and an iCite weighted RCR of 2717. Dr. Pawlik serves on multiple editorial boards and is Editor-in-Chief of Journal of Gastrointestinal Surgery, Deputy Editor of JAMA Surgery, as well as an Associate Editor for Annals of Surgical Oncology. Dr. Pawlik has served on the executive council of several of the premier surgical associations in the United States. Dr. Pawlik is a member of multiple surgical societies including the American Surgical Association, Society of Surgical Oncology, Society of Surgery of the Alimentary Tract, Halsted Society, and Society of Clinical Surgery. Dr. Pawlik is a past-President of the Association for Academic Surgery, past-President of the Americas Hepato-Pancreato-Biliary Association, as well as current co-President of the Surgical Biology II Club. Dr. Pawlik’s international contributions have been recognized through his honorary memberships in the Royal Australasian College of Surgeons, Brazilian Society of Surgical Oncology, Mexican Association for Surgery of the Alimentary Tract, Argentinian Hospital de Clinicas, Portugal Surgical Society, as well as the Society of General Surgeons of Perú and the Peruvian International Hepato-Pancreatobiliary Association. Dr. Pawlik is an Associate Member of the Academy of Master Educators in the ACS. Dr. Pawlik’s research focuses on determinations of factors associated with prognosis and staging of gastrointestinal cancers, as well as the economics of cancer care. He also studies patient/physician communication and patient engagement, as well as social determinants of health related to surgery. Dr. Pawlik has consistently been recognized by Castle Connolly as one of America’s “Top Docs.”

Affiliations and expertise

Professor and Chair, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Professor of Surgery, Oncology, and Health Services Management and Policy, Surgeon in Chief, The Ohio State University Wexner Medical Center, Columbus, Ohio