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Colorectal cancer: Some changes of practices Volume 26, issue 8, Octobre 2019

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Authors
CHU de Toulouse, Institut Universitaire du Cancer, Pôle Hospitalo-Universitaire des Maladies de l’Appareil Digestif, Service d’oncologie médicale digestive, Toulouse
* Correspondance

Second leading cause of cancer death in France, colorectal cancer (CRC) remains a major concern. This last year, several studies changed our practices:

Stage III colon cancer adjuvant chemotherapy for is a standard of treatment for 15 years, with a 6 months FOLFOX chemotherapy. Recently, a very large international collaboration, pooling six prospective studies (>12,000 patients), evaluated a de-escalation to three months of treatment. Although statistical demonstration was not reached, results suggest that a chemo limited to 3-months of XELOX is an option for patients with lower risk (pT3N1 stage).

Immunotherapy by inhibition of immune check points achieved remarkable efficacy in various cancers (melanoma and lung in the first place). For CRC, results are very disappointing, except for the infrequent forms of MSI-CCR (CRC with micro-satellite instability). For these patients, immunotherapy induces high rates of tumor response and prolonged survival. Such level of efficacy should not allow to treat MSI CRC patient without immunotherapy. Numerous of phase II trials confirm good results but only results of phase III trials (eagerly awaited) will lead to French approval. Furthermore, efficacy of checkpoint inhibitor immunotherapy seems to be very promising for localized forms of MSI CCR, achieving impressive levels of sterilization of the primary tumor.

Peritoneal carcinomatosis has long been considered as not accessible to curative treatment. Complete cytoreductive surgery via laparoscopy, limited to selected patients in referral centers, leads to convincing results. Until now these cytoreductive surgery was followed with hyperthermic intraperitoneal chemotherapy (HIPEC). But recently, HIPEC (with oxaliplatin) failed to prove efficacy in the first prospective trial focused on this topic. Also, HIPEC did not demonstrate any efficacy as a preventing approach to prevent peritoneal carcinomatosis in subjects at risk.

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