Molecular Determinants and Other Factors to Guide Selection of Patients for Hepatic Resection of Metastatic Colorectal Cancer

• Published in: Current treatment options in oncology Vol. 22; no. 9; p. 82
• Main Authors: Diehl, Thomas M., Abbott, Daniel E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2021; Springer Nature B.V
• Subjects: Biomarkers, Tumor; Chemotherapy; Clinical Decision-Making; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - etiology; Colorectal Neoplasms - metabolism; Colorectal Neoplasms - pathology; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; Computed tomography; Cytotoxicity; Disease Management; Disease Susceptibility; Genetic screening; Hepatectomy; Hepatectomy - adverse effects; Hepatectomy - methods; Humans; Liver; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Lower Gastrointestinal Cancers (AB Benson; Magnetic resonance imaging; Medicine; Medicine & Public Health; Metastases; Metastasis; Microsatellite Instability; Molecular Diagnostic Techniques; Mutation; Oncology; Patient Selection; Patients; Pelvis; Section Editor; Surgery; Survival; Topical Collection on Lower Gastrointestinal Cancers; Treatment Outcome; KRAS; BRAF; Liver metastasis; Colorectal cancer; Hepatectomy; CRLM
• ISSN: 1527-2729; 1534-6277; 1534-5277
• DOI: 10.1007/s11864-021-00878-5

Opinion statement
Treatment for metastatic colorectal cancer (CRC) has changed significantly over the last few decades as cytotoxic and targeted chemotherapies have evolved and resection of (technically feasible) colorectal liver metastases (CRLM) has become standard of care for eligible patients. Overall, survival for metastatic CRC has considerably improved, but recurrences are common. Numerous clinical risk scores have been suggested to guide patient selection for CRLM resection, but none perfectly predict outcomes; therefore, a personalized approach to metastatic CRC treatment using genetic profiles for risk stratification and prognostication is a critically important advancement. All patients with suspected metastatic CRC should undergo genetic testing for common oncogene mutations (e.g., KRAS, BRAF, and NRAS) in addition to a triphasic CT scan of the chest, abdomen, and pelvis; if hepatectomy may be entertained and there is concern about the future liver remnant (FLR), liver volumetrics should also be performed. MRI and PET are useful adjuncts for cases in which diagnosis or extent of disease is unclear. The decision to operate should be individualized and based on each patient’s condition, tumor biology, and technical resectability. Genetic profiles should be used to inform multidisciplinary meetings surrounding topics of chemotherapy and surgical resection, as well as patient discussions concerning the risks and benefits of surgery. In the end, most patients with technically resectable colorectal cancers and adequate cardiopulmonary fitness benefit from surgical resection, as it remains the only chance of long-term survival.