ASCO GI 2018: Rectal Cancer Take home messages
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1 AIOM Post-ASCO GI 2018 Roma 17 febbraio 2018 ASCO GI 2018: Rectal Cancer Take home messages Carmelo Pozzo UOC di Oncologia Generale Fondazione di Ricerca e Cura Giovanni Paolo II UCSC, Campobasso
2 Current Issues in Rectal Cancer Pre-operative short course radiotherapy Organ preservation: watch and wait Neoadjuvant chemotherapy Adjuvant chemotherapy after pre-op CRT Role of molecular classification, inflammation and microbioma
3 Pre-operative short course radiotherapy Il trattamento ottimale 5 x 5 Gy e chirurgia a 4-8 settimane? La chirurgia ritardata (4-8 sett.) non peggiora la prognosi
4 Preoperative short course radiotherapy Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
5 Preoperative short course radiotherapy Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
6 Organ preservation: watch and wait Studi eterogenei, retrospettivi, senza TME o senza dati su TME e follow-up breve 1054 pz in un database internazionale (IWWD) Studi in corso: TESAR (post-op CRT in medium risk) STAR-TREC (pre-op CRT, intentional organ preservation, basata sulla risposta)
7 Organ preservation: watch and wait Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
8 Organ preservation: watch and wait Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
9 Organ preservation: watch and wait Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
10 Organ preservation: watch and wait Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
11 Neoadjuvant Therapy Forte razionale Incoraggianti risultati in uno studio olandese (Dutch M-1) in pz stadio IV, con metastasi epatiche o polmonari resecabili, con XELOX bevacizumab Vari studi in corso, tra questi anche Total Neoadjuvant Therapy
12 Neoadjuvant chemotherapy? Presented By Andrea Cercek at 2018 Gastrointestinal Cancers Symposium
13 Neoadjuvant chemotherapy? Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
14 Neoadjuvant chemotherapy? Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
15 Neoadjuvant chemotherapy? Presented By Andrea Cercek at 2018 Gastrointestinal Cancers Symposium
16 Adjuvant Chemotherapy? Presented By Andrea Cercek at 2018 Gastrointestinal Cancers Symposium
17 Adjuvant chemotherapy Metanalisi (Cochrane, 21 studi) a favore della terapia diuvante Metanalisi (4 studi euopei): nessun beneficio su riduzione recidive a distanza Solo uno studio con FOLFOX Molti limiti: compliance ridotta e ritardi nell inizio del trattamento
18 Adjuvant Chemotherapy? Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
19 Adjuvant Chemotherapy? Presented By Andrea Cercek at 2018 Gastrointestinal Cancers Symposium
20 Adjuvant Chemotherapy? Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
21 Adjuvant Chemotherapy? Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
22 Adjuvant Chemotherapy? Presented By Andrea Cercek at 2018 Gastrointestinal Cancers Symposium
23 Adjuvant Chemotherapy? Presented By Cornelis Van De Velde at 2018 Gastrointestinal Cancers Symposium
24 Adjuvant Chemotherapy? Presented By Andrea Cercek at 2018 Gastrointestinal Cancers Symposium
25 Impact of other clinical and biological findings (1) Need for an appropriate staging to standardize patients management : AJCC 7 : internal iliac nodes Stage III common/external iliac nodes Stage IV Possible role of systemic inflammation: Low WBC ratio: better outcome after chemoradio LMR (lympho-to-monocite ratio) and NLR: highly prognostic for locally advanced rectal cancer, High LMR: improved OS after short course RT SIR (systemic inflammation response): prognostic role independently of TNM
26 Impact of other clinical and biological findings (2) Molecular Prognostic factors: CMS4 (stromal) associated with local recurrence Mucosal microbioma associated with clicnical features MSI not a predictive marker for neoadjuvant chemoradiotherapy Needs validation!!
27 Grazie per l attenzione
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