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ABSTRACT
The treatment of metastatic CRC (mCRC) has evolved over the last 20 years, from fluoropyrimidines alone to combination chemotherapy and new biologic agents. Median overall survival is now over 24 months for RAS mutated (MT) patients and over 30 months for RAS wild-type (WT) patients. However, there are subgroups of patients with BRAF V600E MT CRC who have a significantly poorer outlook. Newer treatment options are also being explored in select subgroups of patients (anti-HER 2 in HER2 positive mCRC and immunotherapy in patients with defective mismatch repair (dMMR)). The best use of these systemic treatment options, as well as surgery in well-selected patients requires careful consideration of predictive biomarkers and importantly, the optimal sequence in which therapies should be given to derive maximal benefit. A group of colorectal subspecialty medical oncologists from Australia, USA, The Netherlands and Germany met during ECCO 2015 in Vienna to review current practice.
Financial & competing interests disclosure
Australian authors have received honoraria and travel support to attend national and international meetings for colorectal cancer from Merck Serono, AMGEN, Roche and Sanofi Aventis. Subotheni Thavaneswaran has no disclosures. Disclosures for the international faculty are as follows; Prof Dr Cornelis Punt, advisor for Roche, Merck, Amgen, Bayer, Sanofi, Nordic Pharma; Dr Dirk Arnold Research Funding Roche; Prof Daniel Haller Consultant/honoraria, Sanofi-Aventis, Amgen, Genentech; Research funding Roche. The group meeting that enabled the material for this Review to be assembled was supported by an unrestricted educational grant from Roche provided to the ‘Adelaide Colorectal Tumour Group’ which facilitated the meeting. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.