ESMO Preceptorship on Colorectal Cancer 2018

Transcription

1 ESMO Preceptrship n Clrectal Cancer May Valencia, Spain C-Chairs: Andrés CERVANTES (Spain) Dirk ARNOLD (Prtugal) Summary and highlights by Dr. Med. Mac RAMOS 1

2 Friday, 18 May 2018 Sessin 1: Early clrectal cancer. Chair: Rbert Glynne Jnes (UK) Frédéric Bibeau (FR): The pint f view f the pathlgist Quality and Rules f a gd pathlgy reprt Hist-prgnstic factrs: Number f lymph ndes, neural/lymphatic invasin, lymphcytic infiltratin, MSH expressin Mrphlgical and mlecular level analyses (Grading, MSI status, sersa invlvement, immun micrenvirnment, tumr depsits, distant extensin (Venus invasin, Perineural invasin), margins, mlecular prfile (MSI, KRAS, BRAF), liquid bipsy (ctdna)) may have prgnstic and predictive impact (DFS, OS). Regina Beets-Tan (NL): Optimal lc reginal staging fr rectal cancer 2

3 Detailled MRI (better, rather than CT) identify mesrectal fascia tumr invlvement with aceptable bth, sensitivity and specificity, allw raditherapist, surgen and nclgist t plan therapeutic strategy and re- staging. Integrated Diffusin Imaging (DWI) befre Endscpy allwes 8 weeks after Chemraditherapy better assessment (fr cmplete respnse r residual tumr). Eduard Garcia Graner (SP) - State f the art: Standard f surgical practice fr resectable clrectal cancer (special issues n rectal cancer, laparscpy, transanal TNME and rbtic-assisted surgery) Anterir Resectin r (in lwer third Rectum Cancer) Abdmin Perineal Escisin, may let achieve shrt term (prevent cmplicatins, gd pathlgical utcmes) and lng term (Hr QL, Lcal Recurrence, DFS, OS) utcmes. Open mesrectal excisin vs. Laparscpic interventins r rbtic assisted surgery shw similar clinical utcmes. Transanal Ttal Mesrectal Excisin needs adequate patient selectin and surgen training. Rbert Glynne Jnes (UK) - State f the art: Standard(s) f care in the pre-perative treatment fr rectal cancer ESMO Guidelines standard f care stickst a risk adaptative strategy 3

4 Andrés Cervantes (SP) The rle f chemtherapy f lcalized rectal cancer In advanced lc reginal, MRI high risk staged, Rectal Cancer, chem (radi) therapy impact survival utcme. Neadjuvant scre may impact, as surrgate parameter, the final utcme. Sessin 2: Metastatic clrectal cancer, liver limited metastases. Chair: Andrés Cervantes (SP) Chiara Cremlini (IT) - Review f the ESMO cnsensus cnference n metastatic clrectal cancer Basic strategies and grups (RASwt/mut, BRAF mut) Chemtherapy and targeted agents in 1 st line 4

5 Drivers f 1st Line Chice are patient clinical (PS), treatment (intentin: cytreductin r disease stabilizatin), tumr (mlecular: KRAS, BRAF, sidedness, MSI high) characteristics. Fr early, marginally and ptentially resectable tumrs, the treatment aim shuld be the cure. Based n presence f prgnstic factrs, an (xaliplatin based dublet) peri perative apprach may be chsen. Thrugh surgical, lc reginal and systemic appraches, nwadays, previus never resectable may becme technically (ptentially) resectable tumrs. Dirk Arnld (PT) Oligmetastatic clrectal cancer: what t knw abut and hw t treat it Treatment may be selected frm a tlbx f prcedures accrding t lcalisatin, treatment gal ( the mre curative, the mre surgery / higher imprtance f lcal/cmplete cntrl), treatment-related mrbidity, lcal expertise and availability, and patient-related factrs such as cmrbidity/ies and age. 5

6 Sessin 3: Adjuvant settings f clrectal cancer. Chair: Dirk Arnld (PT) Frédéric Bilbeau (FR) RAS, BRAF: Micrsatellite instability and ther mlecular markers- hw useful are they? Pitfalls in diagnstic? In daily nclgic practice: CIN (cnventinal cancers) RAS mutatin (predictive factr) pathway, CIMP (serrated and elderly cancer) prgnstic factr pathway and MSI pathway may be useful bimarkers. 6

7 Michel Ducreux (FR) Adjuvant treatment fr cln cancer II and III Adjuvant chemtherapy is indicated fr stage III (N+) FOLFOX / CapeOx Capecitabine r (inf.) FU/LV as an ptin fr sme patients FOLFOX/CapeOx fr patients < 70y, use with cautin fr pts > 70y. Antibdies (EGFR, VEGF) are nt indicated. The decisin fr an adjuvant treatment shuld balance the risk f cancer mrtality and that f cmrbidities. Demetris Papamichael (CY) Adjuvant treatment fr elderly patients: hw t address it 40% CRC patients are Stadium III. 40% CRC patients are 75 y. 7

8 Scidemgraphic, clinical, research (under- representatin) characteristics f lder than 75 y CRC patients influence Safety and Efficacy f treatment. Sessin 4: Metastatic clrectal cancer. Special clinical situatins. Chair: Andrés Cervantes (SP) Luis Sabater (SP) Hw t integrate surgery in the treatment f patients with liver- nly metastatic disease After pre- perative evaluatin and imaging, surgical eligibility (resectable, fit) patient, pen r laparscpic (less cmplicatins, faster) appraches are available. Radifrequency ablatin r Chememblisatin and 2 step hepatectmy (assciated liver partitin and vein ligatin fr staged hepatectmy) are rather suitable fr unresctable M1 CRC patients. Demetris Papamichael (CY) Hw t deal with elderly patients r individual with cmrbidities 8

9 G8 EORTC Geriatric assessment (functinal (autnmy, cgnitin), psychlgical, cmrbidities, nutritin) may allw identify areas f vulnerability and predict survival. Overall Utility evaluatin fr CRC patients becmes relevant. Luis Sabater (SP) Hw t deal with synchrnus primary and liver metastases Simultaneus liver metastasis and primary bwel Surgery (trend) r sequential bwel first r sequential liver first (always Neadjuvant chemtherapy) cnsidering advantages and disadvantages shw similar efficacy and safety results. 9

10 Michel Ducreux (FR) Hw t deal with patients with islated peritneal metastases The increased effectiveness f systemic chemtherapy (in cmbinatin with targeted chemtherapy) has imprved the survival f patients with peritneal metastases frm clrectal cancer. 10

11 Saturday, 19 May 2018 Sessin 5: Metastatic clrectal cancer. Maintenance and further lines. Chair: Dirk Arnld (PT) Dirk Arnld (PT) The rle f maintenance treatment, apprpriate endpints accrding t ESMO cnsensus After 6-8 weeks FOLFOX r CAPOX inductin, maintenance shuld be cnsidered. Patients with FOLFIRI inductin, maintanence shuld cntinue as lng as shrinkage is present. Dirk Arnld (PT) What t d after 1 st line failure 11

12 75% f patients entering 3. Line have PS 0-1 and Tumr Burden after 1. and 2. Line success is evident 3rd and 4th Line treatment with new agents (TAS-102 r Regrafenib) befre Reintrductin r Rechallenge shuld be cnsidered. In further later lines, Best Supprtive Care is still an ptin. Michel Ducreux (FR) Management f treatment related side-effects: GI txicity, Neurpathy, skin txicity, hypertensin, hand-ft syndrme Management f chemtherapy: Neutrpenia (Stp the 5-FU blus first, then hematlgical grwth factrs r decrease f dses) Thrmbcypenia (Decrease f dses) Mucsitis (Decrease f dses) Diarrhea (High dse f lperamide) 12

13 Special Lecture: Immuntherapy in gastrintestinal cancer. Chair: Dirk Arnld (PT) Elizabeth Smyth (UK) Immuntherapy in gastrintestinal cancer At this time, checkpint blckade with PD-1 r anti-pd-l1 either alne r in cmbinatin with anti-ctla4 therapy has demnstrated the mst prmise fr patients with gastresphageal cancer. Integratin f these therapies with currently used treatments such as chemtherapy and mnclnal anti-bdies such as trastuzumab and ramucirumab is yet t be ptimized Sessin 6: Anal canal tumurs. Chair: Rbert Glynne Jnes (UK) Rbert Glynne Jnes (UK) Standard f care fr anal canal squamus carcinmas 13

14 Primary chemraditherapy is the standard treatment in anal squamus cell carcinma (ASCC). Raditherapy dse escalatin/de-escalatin strategies are currently investigated in ASCC. HPV infectin (70 90% f patients with ASCC are human papillma virus (HPV) psitive) renders ASCC mre immungenic and immuntherapies hld great prmise in primary and metastatic ASCC. Bimarkers and mdern imaging methds are needed fr persnalized treatment. ESMO Preceptrship n Clrectal Cancer. Valencia, Spain. 18th May - 19th May Clrectal-Cancer-2018-Valencia Clrectal-Cancer-Valencia-2018-Prgramme.pdf 14

15 Feedback frm attendee 4 nclgists frm Switzerland had the pssibility t attend this ESMO Preceptrship n Clrectal cancer. Feedback frm Dr. med. Elisabeth Schmidt-Weiss (University Hspital Zürich): Cntent Very nice verview ver the whle tpic f CRC (adjuvant & metastatic) Gd level Organizatin Perfect rganizatin (travel, flight, transfer t htel, htel rm, fd ) Very nice htel (beautiful rms & sight) Cngress in same htel as rm (saved time fr transfer ) Suggestin(s) t imprve the future CRC Preceptrship Leave mre time fr case discussins, this is where we learn mst Time management f speakers can be ptimized (less is mre) Pwer pint slides were ften verladed (less is mre) It wuld be gd t have the slides at the time f presentatin (nt 2 weeks later) t be able t better listen t the speaker & nt be ccupied with taking phts f the slides (because f nt being sure if they really share them later ) 15