The Management of Oligometastatic Disease in Colorectal Cancer: Present Strategies and Future Perspectives

Targeted therapy acts to sensitize stereotactic body radiotherapy for pulmonary oligometastases from colorectal cancer

Background

Stereotactic body radiation therapy (SBRT) is used to manage lung metastases arising from colorectal cancer (CRC), but its effectiveness is constrained by the radioresistance of CRCs. Here, we explored whether concurrent therapy with cetuximab or bevacizumab could improve the prognosis of CRC patients with pulmonary oligometastases.

Materials and methods

CRC patients with oligometastatic lung tumors (OLTs) treated with concurrent chemoradiotherapy from March 2011 to March 2023 were retrospectively analyzed. Treatment outcomes for local control rate (LCR), progression-free survival (PFS), overall survival (OS), and toxicities were assessed.

Results

Sixty-nine patients were included, with a median follow-up of 34 months. The 1-year LCRs for SBRT + chemotherapy, SBRT + chemotherapy + bevacizumab, and SBRT + chemotherapy + cetuximab were 63.3%, 96.2%, and 94.4%, respectively. Incorporating bevacizumab or cetuximab significantly prolonged median OS compared to chemotherapy (61 vs. 46 vs. 24 months). Substantial differences in median PFS were noted, with durations of 5, 23, and 8 months for SBRT + chemotherapy, SBRT + chemotherapy + bevacizumab, and SBRT + chemotherapy + cetuximab, respectively. Our univariate analysis revealed that patients under targeted therapy of bevacizumab or cetuximab were linked to prolonged OS and PFS (p < 0.05). Tumor size <2 cm and median biologically effective dose (BED10) ≥100 Gy were correlated with higher local control rates (p < 0.05). Furthermore, comprehensive multivariate analysis confirmed that tumor sizes of <2 cm were linked to better local control (p < 0.05). All three combination regimens were well tolerated, and the occurrence of toxicities was higher in treatments involving targeted therapy.

Conclusion

Combining concurrent chemoradiotherapy with cetuximab or bevacizumab improves treatment outcomes, with manageable toxicity. Given the limited sample size of this study, larger studies such as prospective trials are needed.

Surgical treatment of synchronous liver-only oligometastatic pancreatic adenocarcinoma: a systematic review and meta-analysis of long-term outcomes

BACKGROUND

The potential long-term survival benefits of surgical resection for synchronous liver-only metastases of pancreatic ductal adenocarcinoma (liver oligo-PDAC) remain controversial. This systematic review and meta-analysis aim to compare the current evidence on long-term survival outcomes between surgical treatment of liver oligo-PDAC and conventional systemic chemotherapy.

MATERIALS AND METHODS

A systematic review and meta-analysis were conducted using the PubMed and Scopus databases to identify studies comparing surgery and systemic chemotherapy in terms of long-term survival in oligo-PDAC patients. The search included studies published up to October 2024. The meta-analysis was performed using the Jamovi software.

RESULTS

Eleven retrospective studies were selected for a total of 897 patients: 565(63%) underwent synchronous resection of liver metastases and the primary tumor, while 332(37%) received conventional chemotherapy. The majority of patients presented a pancreatic head tumor, and the median number of liver metastases ranged between 1 and 3 in the surgical cohort and 1 and 2 in the nonsurgical cohort. The rate of major surgical complications was 14.4% while the cumulative incidence of postoperative mortality was 2.8%. The median overall survival(OS) in the surgical group ranged from 7.6 to 18.4 months, while a lower value comprised between 6 and 9.9 months was evidenced in the nonsurgical cohort. Six studies were included in the meta-analysis for the OS evaluation, showing significantly better survival outcomes in the surgical group (OR: 0.286, 95% CI: 0.100-0.409; P < 0.0001). According to the Q-test, there was no significant heterogeneity in the true outcomes ( Q = 4.063, P = 0.541, I2  = 0 %). A sensitivity analysis, conducted by excluding one study at a time, confirmed the robustness of the meta-analysis findings.

CONCLUSIONS

Surgical resection of oligo-PDAC may represent a valuable treatment option with potential long-term survival benefits. However, prospective randomized trials are required to further validate these findings.

Biomimetic Gd-Metal-Organic Framework Radiosensitizer for Near-Infrared Fluorescence Imaging-Guided Radiotherapy toward Nasopharyngeal Carcinoma

Radiotherapy (RT) is recognized as a primary treatment modality for Nasopharyngeal carcinoma (NPC). However, enhancing RT's targeting accuracy and selectivity remains a significant challenge. In this study, we present an innovative radiosensitizer, Gd-metal-organic framework (MOF)-based nanocarrier coated with indocyanine green (ICG) and red blood cell membrane (RBCM), designed to bypass immune clearance and achieve prolonged circulation within the bloodstream. This design significantly enhances tumor localization and systemic circulation, as evidenced by in vivo analyses. The strategic accumulation of the Gd-MOF-ICG nanocarrier at the tumor site facilitates precise tumor localization and sensitization to RT, leveraging the RBCM camouflage to enhance the tumor uptake potential. Our comprehensive study introduces a potent approach for optimizing RT in NPC treatment through this advanced theranostic nanoplatform, which combines material science with biomedical engineering to augment the effectiveness of RT and underscores the significance of precision in cancer therapy. This strategy offers a promising avenue for clinical application and further research in targeted cancer treatments.

New trends in surgery for colorectal liver metastasis

By presenting the most up-to-date findings and incorporating the latest evidence, this article seeks to present a comprehensive guide for navigating the complexities inherent in the management of colorectal liver metastasis. It aims to serve as a valuable resource offering clinicians and healthcare professionals an understanding of the diverse modalities and approaches available for treating this challenging and multifaceted disease. In an era of rapidly evolving medical knowledge, this article examines the latest insights to make informed decisions in the realm of colorectal liver metastasis management. The article does not only highlight the up-to-date knowledge but also provides the evidence for existing therapeutic strategies. This practical tool provides evidence-based recommendations to clinicians, thereby contributing to the ongoing advancement of effective treatment strategies for this challenging disease.

Feasibility and Tolerability of Anlotinib Plus PD-1 Blockades for Patients with Treatment-Refractory Metastatic Colorectal Cancer: A Retrospective Exploratory Study

Objective

Therapeutic regimens are relatively scarce among patients with treatment-refractory metastatic colorectal cancer (CRC). This study aimed to determine the feasibility and tolerability of anlotinib plus PD-1 blockades in patients with treatment-refractory metastatic CRC retrospectively.

Methods

A total of 68 patients with previously treated metastatic CRC who received anlotinib plus PD-1 blockades in clinical practice were included in this study retrospectively. Demographic and clinical characteristics of the patients, therapeutic outcomes and safety profile during administration were collected and briefly analyzed. All subjects were followed up regularly. Therapeutic outcomes, including drug response and prognosis, were presented, and a safety profile was depicted to illustrate the adverse reactions.

Results

A total of 68 patients with treatment-refractory metastatic CRC who received anlotinib plus PD-1 blockades in clinical practice were included in the final analysis. Best therapeutic response during treatment indicated that partial response was observed in 11 patients, stable disease was noted in 41 patients, and progressive disease was found in 16 patients, producing an objective response rate of 16.2% (95% CI: 8.4%-27.1%) and a disease control rate of 76.5% (95% CI: 64.6%-85.9%). Prognostic analysis suggested that the median progression-free survival (PFS) of the 68 patients was 5.3 months (95% CI: 3.01-7.59), and the median overall survival (OS) was 12.5 months (95% CI: 9.40-15.60). Of the 11 patients who responded, the median duration of response was 6.7 months (95% CI: 2.89-10.53). Safety profile during treatment showed that patients experienced adverse reactions regardless of grade, and grade ≥3 adverse reactions were found in 61 patients (89.7%) and 41 patients (60.3%), respectively. Common adverse reactions were hypertension, myelosuppression (including leukopenia, neutropenia, thrombocytopenia, and anemia), fatigue, and hand-foot syndrome.

Conclusion

Anlotinib plus PD-1 blockades demonstrated encouraging efficacy and acceptable safety profile in patients with treatment-refractory metastatic CRC preliminarily in clinical practice. This conclusion should be confirmed in prospective clinical trials.