Take your knowledge of colorectal cancer to the next level! Aimed at postgraduate learners (i.e. intern, resident, fellow) and generalists who want to learn more about colorectal cancer workup and treatment, as well as those working in oncology who would like a little refresher.
CRC BtB Slide Deck
Summary
This on-demand teaching session led by Beatrice Preti provides in-depth knowledge about the workup, trials, and treatment of colorectal cancer. The session employs interactive elements such as polls, chats, and collaboration ideas. Participants will learn how to plan a proper workup for suspected patients, understand the role of PET scans, and apply the treatment strategies based on the stage of the disease. The session also covers the role of targeted therapies, neoadjuvant options for rectal cancer, and surveillance strategies post-curative therapy. Medical professionals can benefit from this session to enhance their knowledge and skills in treating colorectal cancer.
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Description
Learning objectives
- Understand and accurately describe the diagnostic process for detecting colorectal cancer, including relevant tests and their interpretations.
- Identify and discuss five key clinical trials that have shaped the current management approach to colorectal cancer, and implement these learnings in their practice.
- Understand the stage-specific treatment approaches for colorectal cancer, and tailor treatment plans based on the patient's specific stage and clinical condition.
- Gain familiarity with the side effects and potential complications of primary and adjunctive therapies used in colorectal cancer treatment.
- Understand the importance of post-treatment surveillance for colorectal cancer and plan an appropriate follow-up schedule for patients post curative therapy.
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June 27 2024 Beatrice Preti bpreti@qmed.caBy the end of this session, participants should be able to… • Plan an appropriate workup for a patient with suspected colorectal cancer with 100% accuracy • Describe at least 5 key trials in the treatment of colorectal cancer and use these in clinical practice • Demonstrate an understanding of treatment for a patient with various stages of colorectal cancerWhat tests would be included in the workup for colon cancer? Pchat!n the Full Bloodwork Tissue Biopsy CT Chest/Abdomen/Pelvis CEA Poll! CT scans with or without contrast?What is the role of PET scans?Please write out your bloodwork order for a new patient with CRC. Post in the chat!Stage I Colon Cancer: what adjuvant treatment is recommended? Post in the chat!*PICTURE SLIDE: Stage II: High-Risk Features • T4 primary • High grade/poorly differentiated • LVI/PNI • Bowel obstruction/tumour perforation • < 12 lymph nodes • Elevated pre-op CEA (ESMO) • Positive margins (NCCN) • Tumour Budding 10+ buds (ASCO)Sneaky Snippets about Stage II Colon CancerSneaky Snippets about Stage II Colon Cancer Duration of treatment...?Sneaky Snippets about Stage II Colon Cancer MSI-H = Duration of protective treatment...? factorSneaky Snippets about Stage II Colon Cancer MSI-H = Duration of protective treatment...? factor Does oxaliplatin help in patients > 70?Poll: What defines stage III colon cancer?Idea CollaborationName a side effect associated with capecitabine, NOT 5-FU. Post in the chat!Poll: Is there evidence about giving FOLFIRI in the adjuvant setting? Mixed Evidence for Neoadjuvant T reatment in Colon Cancer • FOxTROT = perioperative chaemo improves two-year DFS • OPTICAL, NeoCol trials = no perioperative benefit Bottom Line Stage I: Stage II: Surgery Only Consider Risks Stage III: What if the Adjuvant patient is frail? FOLFOX/XELOX First-Line Options FOLFOXIRI FOLFIRI FOLFOX XELOX …XELIRI? Adjuncts Bevacizumab Panitumumab Cetuximab *Dr Preti's* Preferred Lines of Therapy 1. FOLFIRI +/- Adjunct (1st line no surgery) 2. FOLFOX +/- Adjunct (1st line if surgery) 3. Lonsurf +/- Bevacizumab 4. Regorafenib 5. …fruquitinib, Phase I clinical trial Targeted Therapies • BRAF V600E Mutation: cetuximab/encorafenib (BEACON) • BEACON: triple therapy (enco/bini/cetux) was NOT superior to doublet • KEYNOTE 177: Pembrolizumab (MSI-H) • New evidence for ipilimumab/nivolumab coming through • ...other NGS (HER2, TMB)Final note on ctDNAPoll: Stage by stage, which is considered more aggressive?Rectal Cancer Neoadjuvant Options "Short course" radiation Chaemoradiation Radiation, then Chaemotherapy chaemotherapy …immunotherapy "TNT" = T otal Neoadjuvant Therapy • cT3/T4 • Node positive • Threatened margins/sphincter Rectal Cancer T rials • OPRA: CRT --> Chaemo • PRODIGE: weird neoadjuvant/adjuvant • RAPIDO: used short-course radiation • Dostarlimab Trial: 100% complete response in 12 patients!!!Please write your strategy for CRC surveillance post-curative therapy . Post in the chat!