memo - Magazine of European Medical Oncology

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Patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer

Horvath, Philipp;Königsrainer, Ingmar

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00633-w

Summary Background Colorectal cancer is the most common origin of peritoneal metastasis in total, with 15% metastasizing to the peritoneum. In order to provide satisfactory peritoneal recurrence-free survival and low morbidity and mortality rates appropriate patient selection is crucial. Methods Literature research (Pubmed) from 2013 to 2020 was performed including the terms “colorectal”, “peritoneal”, “metastasis”, “cytoreductive surgery”, “HIPEC” and “patient selection”. Results and conclusion Despite predictive models the rate of non-therapeutic laparotomy is still high. Patients evaluated for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) should ideally undergo laparoscopy. CRS and HIPEC should be scheduled if a completeness of cytoreduction (CC)-0 score is achievable with a moderate peritoneal cancer index (PCI) (<15), ≤ three resectable liver metastases and, if applied, response to systemic chemotherapy. Signet ring histology can be seen as a relative contraindication. Presence of mutations (RAS/RAF), disease setting, primary tumor side, lymph node ratio and time point of systemic chemotherapy do not impact the treatment algorithm as yet.
journal article
LitStream Collection
San Antonio Breast Cancer Symposium 2019: human epidermal growth factor receptor 2(HER2)-positive breast cancer and image-guided biopsy to detect pathologic complete response (pCR)

Dormann, Clemens

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00632-x

Summary At the 2019 San Antonio Breast Cancer Symposium, new data on the management of heavily pretreated human epidermal growth factor receptor 2(HER2)-positive metastatic breast cancer were discussed. The phase 3 HER2CLIMB and the phase 2 DESTINY-Breast01 trials investigating tucatinib and trastuzumab deruxtecan, respectively, have met their primary endpoints. In an early disease setting, four studies investigated whether image-guided biopsies could identify patients with a pathologic complete response (pCR) to neoadjuvant chemotherapy, thus allowing safe omission of surgery. As residual disease was missed in a significant number of cases, these trials could not confirm data from smaller previous studies.
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