López Roberto Ivan, Castro Jenny Lissette, Cedeño Heidy, Cisneros Dagoberto, Corrales Luis, González-Herrera Ileana, Lima-Pérez Mayté, Prestol Rogelio, Salinas Roberto, Soriano-García Jorge Luis, T Zavala Alejandra, Zetina Luis Miguel, Zúñiga-Orlich Carlos Eduardo
Oncology Department, National Oncological Institute, Panama City, Panama.
Department of Medical Oncology, Oncology Hospital, Salvadorian Institute of Social Security, Rosales National Hospital, San Salvador, El Salvador.
ESMO Open. 2018 Mar 15;3(3):e000315. doi: 10.1136/esmoopen-2017-000315. eCollection 2018.
Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women worldwide. In Latin America and the Caribbean, it has a mortality of 56%. The median overall survival for patients with metastatic colorectal cancer (mCRC) is currently estimated as ~30 months, which has substantially improved through strategic changes in treatment and in the management of patients. As opposed to other metastatic cancers where first-line regimens are often determined, mCRC requires special attention because there is controversy in the possible combinations of the available drugs and the different periods of duration for each patient. Each combination must seek to be effective and to generate the minimum adverse effects as possible. Instead of giving the first-line regimen until the tumour progresses, treatment is often individualised. Furthermore, up to 60% of colorectal tumours are considered non-mutated or wild-type CRC. Not harbouring mutations in the RAS family of genes or mutations in the signalling pathways of the epidermal growth factor receptor causes a null response to anti-epidermal growth factor receptor antibody therapy, which implies even more complex considerations regarding its management. The primary objective of this consensus is to address the main scenarios of mCRC in order to warrant the most appropriate therapeutic intervention for these patients in the Central American and the Caribbean (CAC) region. This can lead to better clinical outcomes as well as quality of life for palliative patients. This document includes the formal expert consensus recommendations for scenarios of mutated and non-mutated mCRC, including synchronous or metachronous disease, management of mCRC with liver and lung metastasis, resectable, potentially resectable or non-resectable tumours and local in the CAC context.
结直肠癌（CRC）是全球男性中第三大常见癌症，女性中第二大常见癌症。在拉丁美洲和加勒比地区，其死亡率为56%。目前估计转移性结直肠癌（mCRC）患者的中位总生存期约为30个月，通过治疗策略和患者管理的改变，这一生存期已大幅改善。与其他常确定一线治疗方案的转移性癌症不同，mCRC需要特别关注，因为可用药物的可能组合以及每位患者的不同疗程存在争议。每种组合都必须力求有效并产生尽可能小的不良反应。治疗通常是个体化的，而不是一直给予一线治疗方案直到肿瘤进展。此外，高达60%的结直肠肿瘤被认为是非突变型或野生型CRC。RAS基因家族未发生突变或表皮生长因子受体信号通路未发生突变会导致对抗表皮生长因子受体抗体治疗无反应，这意味着在其管理方面需要更复杂的考虑。本共识的主要目标是解决mCRC的主要情况，以便为中美洲和加勒比地区（CAC）的这些患者提供最合适的治疗干预。这可以为姑息治疗患者带来更好的临床结果以及生活质量。本文档包括针对突变型和非突变型mCRC情况的正式专家共识建议，包括同时性或异时性疾病、伴有肝肺转移的mCRC管理、可切除、潜在可切除或不可切除肿瘤以及CAC背景下的局部情况。
