CRC with peritoneal metastases: refining the CRS-HIPEC approach

  • ESMO WCGC 2020
  • 3 Jul 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • Results of 4 studies presented at the European Society for Medical Oncology (ESMO) 22nd World Congress on Gastrointestinal Cancer suggest that patients with colorectal cancer (CRC) and peritoneal metastases should be treated only in a specialized referral center and receive systemic chemotherapy before cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

Why this matters

  • Whether HIPEC or systemic therapy is the best chemotherapeutic approach for CRC with peritoneal metastases remains controversial.

Key highlights

  • Pilot phase findings from the ongoing randomized phase 3 CAIRO6 trial comparing CRS-HIPEC plus perioperative systemic therapy vs CRS-HIPEC alone showed that systemic therapy could successfully induce radiological and pathological tumor responses.
  • A Dutch observational study found no significant difference in survival outcomes between HIPEC patients treated with mitomycin C vs those treated with oxaliplatin (OS at 3 years: 44.7% vs 53.5%).
  • A propensity score-matched analysis of a Dutch nationwide registry showed that the addition of adjuvant systemic chemotherapy after CRS-HIPEC was associated with significant improvement in OS compared with active surveillance (39 vs 24 months).
  • A Spanish population-based regional program to optimize the management of peritoneal CRC metastases showed that survival outcomes were excellent after CRS-HIPEC when patients were optimally selected, and defined clinical pathways and protocols were implemented.