Stage IV Colorectal Cancer at Initial Presentation versus Progression during and after Treatment, Differences in Management: Management Differences for Initial Presentation versus Progression of Disease after Initial Treatment

Abstract

Stage IV colorectal cancer is a prevalent disease and understanding the appropriate treatment options is important. Medical oncologic treatment remains the mainstay of treatment in cases where curative resection is not possible. Surgical intervention is indicated if the primary tumor and associated metastases are amenable to curative resection or if obstructive, bleeding, or perforative complications arise from the tumor. New endoscopic techniques can provide palliation and benefit for patients who cannot undergo surgery and may speed time to chemotherapy initiation. Recently, immunotherapy has shown promise at managing, controlling, and regressing advanced disease, in some cases converting it to curative with resection. For patients that progress while on treatment, continued medical therapy remains the mainstay of treatment. Further research into the benefits of asymptomatic primary tumor resection without curative intent needs to be performed. Colorectal cancer, and more specifically metastatic colorectal cancer, continues to have improved 1- and 5-year survival rates and likely will continue to do so over the coming months and years.

Keywords

metastatic colorectal cancer - stage IV colorectal cancer

^* Co-authors.

Publication History

Article published online:
16 April 2023

• References

• 1 NCI Dictionary of Cancer terms. National Cancer Institute. Accessed October 3, 2022 at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/colorectal-cancer
• 2 NCCN. Published February 25, 2022. Accessed October 4, 2022 at: https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf
• 3 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022; 72 (01) 7-33
• 4 Cancer facts & figures 2022. American Cancer Society. Published 2022. Accessed October 3, 2022 at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2022.html
• 5 Crooke H, Kobayashi M, Mitchell B. et al. Estimating 1- and 5-year relative survival trends in colorectal cancer (CRC) in the United States: 2004 to 2014. J Clin Oncol 2018; 36 (4, suppl): 587-587
• 6 Majumdar SR, Fletcher RH, Evans AT. How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol 1999; 94 (10) 3039-3045
• 7 John SK, George S, Primrose JN, Fozard JB. Symptoms and signs in patients with colorectal cancer. Colorectal Dis 2011; 13 (01) 17-25
• 8 Issa IA, Noureddine M. Colorectal cancer screening: an updated review of the available options. World J Gastroenterol 2017; 23 (28) 5086-5096
• 9 Chiorean EG, Nandakumar G, Fadelu T. et al. Treatment of patients with late-stage colorectal cancer: ASCO Resource-Stratified Guideline. JCO Glob Oncol 2020; 6 (06) 414-438
• 10 Cheynel N, Cortet M, Lepage C, Benoit L, Faivre J, Bouvier A-M. Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum 2007; 50 (10) 1568-1575
• 11 Pisano M, Zorcolo L, Merli C. et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 2018; 13 (01) 36
• 12 Lee YM, Law WL, Chu KW, Poon RTP. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192 (06) 719-725
• 13 Stillwell AP, Buettner PG, Ho Y-H. Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg 2010; 34 (04) 797-807
• 14 Venderbosch S, de Wilt JH, Teerenstra S. et al. Prognostic value of resection of primary tumor in patients with stage IV colorectal cancer: retrospective analysis of two randomized studies and a review of the literature. Ann Surg Oncol 2011; 18 (12) 3252-3260
• 15 Liang J, Church JM, Stocchi L, Fazio V, Kiran RP. Should bypass or stoma creation be undertaken for unresectable stage IV colorectal carcinoma?. ANZ J Surg 2014; 84 (04) 275-279
• 16 Finlayson A, Hulme-Moir M. Palliative colonic stenting: a safe alternative to surgery in stage IV colorectal cancer. ANZ J Surg 2016; 86 (10) 773-777
• 17 Lim T-Z, Chan DKH, Tan K-K. Endoscopic stenting should be advocated in patients with stage IV colorectal cancer presenting with acute obstruction. J Gastrointest Oncol 2018; 9 (05) 785-790
• 18 Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX. Comparison of efficacy between uncovered and covered self-expanding metallic stents in malignant large bowel obstruction: a systematic review and meta-analysis. Colorectal Dis 2012; 14 (07) e367-e374
• 19 Takahashi H, Okabayashi K, Tsuruta M, Hasegawa H, Yahagi M, Kitagawa Y. Self-expanding metallic stents versus surgical intervention as palliative therapy for obstructive colorectal cancer: a meta-analysis. World J Surg 2015; 39 (08) 2037-2044
• 20 van Halsema EE, van Hooft JE, Small AJ. et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 2014; 79 (06) 970-82.e7 , quiz 983.e2, 983.e5
• 21 Fernández-Esparrach G, Bordas JM, Giráldez MD. et al. Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. Am J Gastroenterol 2010; 105 (05) 1087-1093
• 22 Modest DP, Pant S, Sartore-Bianchi A. Treatment sequencing in metastatic colorectal cancer. Eur J Cancer 2019; 109: 70-83
• 23 Guo Y, Xiong B-H, Zhang T, Cheng Y, Ma L. XELOX vs. FOLFOX in metastatic colorectal cancer: an updated meta-analysis. Cancer Invest 2016; 34 (02) 94-104
• 24 Guo Y, Shi M, Shen X, Yang C, Yang L, Zhang J. Capecitabine plus irinotecan versus 5-FU/leucovorin plus irinotecan in the treatment of colorectal cancer: a meta-analysis. Clin Colorectal Cancer 2014; 13 (02) 110-118
• 25 Yamazaki K, Nagase M, Tamagawa H. et al. Randomized phase III study of bevacizumab plus FOLFIRI and bevacizumab plus mFOLFOX6 as first-line treatment for patients with metastatic colorectal cancer (WJOG4407G). Ann Oncol 2016; 27 (08) 1539-1546
• 26 Hochster HS, Hart LL, Ramanathan RK. et al. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study. J Clin Oncol 2008; 26 (21) 3523-3529
• 27 Hurwitz H, Fehrenbacher L, Novotny W. et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004; 350 (23) 2335-2342
• 28 Wrobel P, Ahmed S. Current status of immunotherapy in metastatic colorectal cancer. Int J Colorectal Dis 2019; 34 (01) 13-25
• 29 Lenz H-J, Van Cutsem E, Luisa Limon M. et al. First-line nivolumab plus low-dose ipilimumab for microsatellite instability-high/mismatch repair-deficient metastatic colorectal cancer: the phase II checkmate 142 study. J Clin Oncol 2022; 40 (02) 161-170
• 30 Tabernero J, Melero I, Ros W. et al. Phase IA and IB studies of the novel carcinoembryonic antigen (CEA) T-Cell Bispecific (CEA CD3 TCB) antibody as a single agent and in combination with atezolizumab: Preliminary efficacy and safety in patients with metastatic colorectal cancer (MCRC). J Clin Oncol 2017; 35 (15, suppl): 3002-3002
• 31 Magee MS, Abraham TS, Baybutt TR. et al. Human GUCY2C-targeted chimeric antigen receptor (car)-expressing T cells eliminate colorectal cancer metastases. Cancer Immunol Res 2018; 6 (05) 509-516
• 32 Geevarghese SK, Geller DA, de Haan HA. et al. Phase I/II study of oncolytic herpes simplex virus NV1020 in patients with extensively pretreated refractory colorectal cancer metastatic to the liver. Hum Gene Ther 2010; 21 (09) 1119-1128
• 33 Charnsangavej C, Clary B, Fong Y, Grothey A, Pawlik TM, Choti MA. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13 (10) 1261-1268
• 34 Sheth KR, Clary BM. Management of hepatic metastases from colorectal cancer. Clin Colon Rectal Surg 2005; 18 (03) 215-223
• 35 Rena O, Casadio C, Viano F. et al. Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience. Eur J Cardiothorac Surg 2002; 21 (05) 906-912
• 36 Milosevic M, Edwards J, Tsang D. et al. Pulmonary metastasectomy in colorectal cancer: updated analysis of 93 randomized patients - control survival is much better than previously assumed. Colorectal Dis 2020; 22 (10) 1314-1324
• 37 Tan WJ, Patil S, Guillem JG. et al. Primary tumor-related complications and salvage outcomes in patients with metastatic rectal cancer and an untreated primary tumor. Dis Colon Rectum 2021; 64 (01) 45-52