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Copyright ©The Author(s) 2023.
World J Gastroenterol. Mar 14, 2023; 29(10): 1569-1588
Published online Mar 14, 2023. doi: 10.3748/wjg.v29.i10.1569
Table 1 Modifiable and non-modifiable risk factors and preventive factors for colorectal cancer
ModifiableNon-modifiable
Risk factorsExcess body fatFamily history of CRC
Sedentary life-styleAdvanced polyps
Westernized dietPolyposis syndrome (FAP, MAP)
Processed meatsLynch syndrome (HNPCC)
Red meatsBlack people
Older age
Male
Preventive factorsHigh fiber dietFemale
Whole grain diet
No alcohol
No smoking
Table 2 Chemotherapy and targeted therapies for metastatic colorectal cancer patients
Ref.
Country
Drug(s)
Number of patients
Study phase
ORR, %
Mean OS in mo
Mean PFS in mo
Results
Resectable CLM with no extra-hepatic metastasis
Gruenberger et al[42]AustriaCapecitabine, oxaliplatin plus bevacizumab56273.2--Bevacizumab can be safely administered until 5 wk before liver resection in patients with metastatic CRC without increasing the rate of surgical or wound healing complications or the severity of bleeding
Bridgewater et al[43]United KingdomOxaliplatin, L-folinic acid, fluorouracil or capecitabine, oxaliplatin plus cetuximab2573-81.0/55.4 (Chemo/Chemo+)22.2/15.5 (Chemo/Chemo+)In the perioperative setting, patients with operable diseases are at a disadvantage in terms of OS; hence, cetuximab should not be used in this setting
Unresectable CLM with potential for resection and no extra-hepatic metastasis
Wong et al[44]United KingdomCapecitabine, oxaliplatin plus bevacizumab46-78.0--A high response rate for patients with CLMs with poor-risk features not selected for upfront resection and converted 40% of patients to resectability
Gruenberger et al[45]United Kingdom, Austria, France, and SpainBevacizumab plus FOLFOX-6 (5-fluorouracil folinic acid oxaliplatin) or FOLFOXIRI (5-fluorouracil folinic acid oxaliplatin irinotecan)80281/62 (BF/BF6)-18.6/11.5 (BF/BF6)In patients with CLM that were originally unresectable, bevacizumab-FOLFOXIRI was correlated with better response and resection rates as well as a longer PFS than bevacizumab-mFOLFOX-6
Garufi et al[47]ItalyCetuximab plus chrono-IFLO (chrono-irinotecan 5-fluorouracil leucovorin oxaliplatin)432-37-Cetuximab in combination with chrono-IFLO resulted in 60% full resectability of CLM patients
Folprecht et al[48]GermanyCetuximab plus FOLFOX (5-fluorouracil folinic acid oxaliplatin) or FOLFOXIRI (5-fluorouracil folinic acid oxaliplatin irinotecan)56/55 (CFX/CFI)--35.7/29.0 (CFX/CFI)10.8/10.5 (CFX/CFI)Both FOLFOX/FOLFIRI with cetuximab appear to be effective conversion therapy regimens in patients with KRAS codon 12/13/61 wild-type tumors. Thus, liver surgery can be deemed curative or as a second line of therapy in people who are not cured
Unresectable CLM
Rivera et al[50]Spain, Germany, United States, Belgium, Switzerland, and ItalymFOLFOX6 plus panitumumab or bevacizumab170/156 (RAS WT/RAS WT/BRAF WT)-RAS WT 65/60, RAS WT/BRAF WT 65/62 (FXP/FXB)RAS WT 36.9/28.9, RAS WT/BRAF WT 46.3/28.9 (FXP/FXB)RAS WT 12.8/10.1, RAS WT/BRAF WT 13.1/10.1 (FXP/FXB)Panitumumab in combination with mFOLFOX6 is a successful first-line therapy for individuals with RAS WT and RAS WT/BRAF WT mCRC
Stintzing et al[53]GermanyFOLFIRI (5-fluorouracil leucovorin irinotecan) plus cetuximab or bevacizumab400365.3/58.7 (FIC/FIB)33.1/25.0 (FIC/FIB)10.3/10.2 (FIC/FIB)In the first-line therapy of patients with RAS wild-type metastatic colorectal cancer, FOLFIRI with cetuximab may be preferable than FOLFIRI plus bevacizumab
Pfeiffer et al[58]DenmarkTrifluridine plus tipiracil hydrochloride (TAS-102) or TAS-102 plus bevacizumab47/46 (T/TB)251/67 (T/TB)6.7/9.4 (T/TB)2.6/4.6 (T/TB)In terms of efficacy and safety, bevacizumab may be an effective companion for TAS-102 in patients with chemorefractory metastatic colorectal cancer
Cremolini et al[59]ItalyCetuximab plus irinotecan 13/12 (RWT/RMT)2-12.5/5.2 (RWT/RMT)4.0/1.9 (RWT/RMT)In patients with RAS and BRAF wild-type mCRC who have acquired resistance to first-line irinotecan and cetuximab-based treatment, a re-challenge approach with cetuximab and irinotecan may be effective. The examination of RAS mutational status on cDNA may aid in the selection of potential patients
Sartore-Bianchi et al[60]ItalyPanitumumab (re-challenge)25-3013.74Interventional liquid biopsies can be used efficiently and safely to guide anti-EGFR re-challenge treatment with panitumumab in patients with mCRC
Kopetz et al[63]United States Irinotecan cetuximab or irinotecan cetuximab plus vemurafenib50/50 (IC/ICV)--12/12 (IC/ICV)2.0/4.2 (IC/ICV)Vemurafenib in combination with cetuximab and irinotecan is an active combination that increases PFS. This is a well-planned research based on a solid grasp of the mechanisms of adaptive resistance in mCRC
Tabernero et al[64]United States, France, Italy, Spain, United Kingdom, Germany, Australia, Hong Kong, Norway, Switzerland, Japan, South Korea, and the NetherlandsEncorafenib cetuximab binimetinib or encorafenib cetuximab or FOLFIRI cetuximab224/220/221 (3D/2D/CD)326.8/19.5/1.8 (3D/2D/CD)9.3/9.3/5.9 (3D/2D/CD)-When compared to conventional chemotherapy, encorafenib plus cetuximab improved OS, ORR, and progression-free survival in previously treated patients with metastatic disease. Encorafenib with cetuximab is a new standard-of-care regimen for previously treated patients with BRAF V600E mCRC, according to main and revised studies
Siena et al[68]United States, Italy, United Kingdom, Spain, and JapanTrastuzumab deruxtecan (DS-8201)53/7/18 (A/B/C)245.3 (A)5.4 (A)6.9 (A)Trastuzumab deruxtecan shown promising and sustained effect in HER2-positive mCRC that was resistant to conventional therapy, as well as a favorable safety profile
Mayer et al[71]Belgium, Italy, Japan, Spain, Australia, and United StatesTrifluridine plus tipiracil hydrochloride (TAS-102) or placebo800 (2:1)-1.6/0.4 (TAS/placebo)7.1/5.3 (TAS/placebo)2.0/1.7 (TAS/placebo)A significant number of Japanese and Western patients with mCRC who had had a lot of prior treatment, including those whose condition was resistant to fluorouracil, were shown to respond clinically to TAS-102