Dual-track oncologic-metabolic treatment in patients with colorectal carcinoma and clinical obesity – a case series report of the Oncologic-Metabolic Board, Comprehensive Cancer Center Freiburg

Background: Many oncologic patients present with severe obesity and metabolic disorders. They face particularly complex challenges. In clinical practice, obesity management comes secondary to oncologic care. In fact, weight-loss therapy has traditionally been contraindicated in cancer therapy, especially due to the known association between involuntary weight loss and poor prognosis in cancer patients. Here, we report on a dual-track approach in patients with colorectal carcinoma and clinical obesity.

Methods: Initial patient BMI ranged between 32.5 and 65.7 kg/m². All patients fulfilled the new obesity definition criteria of clinical disease. Oncological therapy was in accordance with current guidelines. All patients were metabolically screened and discussed in our multi-disciplinary oncologic-metabolic board. In parallel to oncologic treatment, patients received multimodal obesity therapy including low-dose incretine therapy in combination with individualized nutrition and resistance training regimens as part of a novel “dual-track” approach. At screening and during therapy, we conducted in-depth clinical phenotyping including anthropometric, laboratory and body composition data. Patients were metabolically staged using the Edmonton Obesity Staging System (EOSS) and the new definition criteria of obesity.

Results: All patients achieved clinically relevant weight loss during neoadjuvant therapy and preoperative preparation. We observed improvement of physical functionality and dramatic reduction of obesity associated risk factors, including uncontrolled arterial hypertension, severe sleep apnea, and poorly controlled diabetes. We observed an increase in fat-free mass and skeletal muscle. All patients became eligible for and underwent curative oncologic surgery. There were no discernible negative effects regarding tumor progression detected relating to weight loss. Importantly, all patients experienced a heightened sense of empowerment and engagement over treatment outcomes and exhibited exceptional compliance.

Conclusion: These cases suggest that evaluation of this novel dual-track neoadjuvant therapy may be warranted for selected patients.

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Artikel online veröffentlicht:
04. September 2025