Modern strategy of metastatic colorectal cancer treatment (literature review)

Metastatic lesions account for about 50–60 % of all cases of colorectal cancer (CRC). Currently, the prognosis for metastatic CRC has significantly improved due to the advent of effective drug therapy and the expansion of surgical treatment options. In this regard, the study of modern directions of treatment of metastatic CRC is of particular interest.

In this study, both literature data and obtained treatment results of patients with metastatic colorectal cancer have been analyzed (PubMed, Scopus, eLibrary databases were used) at the National Medical Research Centre for Oncology.

Currently, many factors should be taken into account when planning therapy for patients with metastatic CRC: the characteristics of the tumor itself (biology and localization of the tumor, tumor burden, RAS, BRAF mutational status), the patient (age, performance status, functional state of organs and systems, comorbidity, patient attitude, expectations and preferences) and the treatment itself (toxicity, flexibility of the treatment program, socio-economic factors, quality of life). With a resectable process, surgical treatment with adjuvant or perioperative chemotherapy, and with potentially resectable liver metastases, with massive prevalence, unfavorable prognosis - to carry out the most active drug therapy taking into account the mutational status of the tumor in order to transfer the process to a resectable one. In case of widespread colorectal cancer, drug therapy lines are consistently carried out, the selection of which is based on the goals of therapy, the type and time of primary therapy, the mutation profile of the tumor, and the toxicity of drugs.

Patients with metastatic liver and/or lung lesions should be considered through the prism of surgical treatment, since it is surgical intervention that can significantly improve the results of treatment of patients. Therefore, patients with potentially resectable metastases should receive the most effective treatment and be operated on as soon as the process becomes resectable. At the same time, modern chemotherapy and targeted therapy are an integral part of the treatment of patients with metastatic colorectal cancer.

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