Department of Gastroenterology and Digestive Oncology, University Hospital of Saint Etienne, Saint Etienne, France.
Department of Gastroenterology, University Hospital of Poitiers, Poitiers, France.
Dig Liver Dis. 2019 Oct;51(10):1357-1363. doi: 10.1016/j.dld.2019.05.035. Epub 2019 Jul 15.
This document is a summary of the French intergroup guidelines regarding the management of metastatic colorectal cancer (mCRC) published in January 2019, and available on the French Society of Gastroenterology website (SNFGE) (www.tncd.org).
This collaborative work was realized by all French medical and surgical societies involved in the management of mCRC. Recommendations are graded in three categories (A, B and C), according to the level of evidence found in the literature, up until December 2018.
The management of metastatic colorectal cancer has become complex because of increasing available medical, radiological and surgical treatments alone or in combination. The therapeutic strategy should be defined before the first-line treatment, mostly depending on the presentation of the disease (resectability of the metastases, symptomatic and/or threatening disease), of the patient's condition (ECOG PS, comorbidities), and tumor biology (RAS, BRAF, MSI). The sequence of targeted therapies also seems to have an impact on the outcome (angiogenesis inhibition beyond progression). Surgical resection of metastases was the only curative intent treatment to date, joined recently by percutaneous tumor ablation tools (radiofrequency, microwave). Localized therapies such as hepatic intra-arterial infusion, radioembolization and hyperthermic intraperitoneal chemotherapy, also have seen their indications specified (liver-dominant disease and resectable peritoneal carcinomatosis). New treatments have been developed in heavily pretreated patients, increasing overall survival and preserving quality of life (regorafenib and trifluridine/tipiracil). Finally, immune checkpoint inhibitors have demonstrated high efficacy in MSI mCRC.
French guidelines for mCRC management are put together to help offer the best personalized therapeutic strategy in daily clinical practice, as the mCRC therapeutic landscape is complexifying. These recommendations are permanently being reviewed and updated. Each individual case must be discussed within a multidisciplinary team (MDT).
本文档是 2019 年 1 月发表在法国胃肠病学会（SNFGE）网站（www.tncd.org）上的法国多学科专家组关于转移性结直肠癌（mCRC）管理的指南摘要。
本协作工作由参与 mCRC 管理的所有法国医学和外科学会共同完成。推荐意见根据截至 2018 年 12 月的文献中发现的证据水平分为 A、B 和 C 三个类别。
由于仅或联合使用越来越多的医疗、放射和手术治疗方法，转移性结直肠癌的治疗变得复杂。治疗策略应在一线治疗前确定，主要取决于疾病的表现（转移灶的可切除性、症状性和/或威胁性疾病）、患者的情况（ECOG PS、合并症）和肿瘤生物学（RAS、BRAF、MSI）。靶向治疗的顺序似乎也对结果有影响（进展后抗血管生成抑制）。迄今为止，手术切除转移灶是唯一具有治愈意图的治疗方法，最近加入了经皮肿瘤消融工具（射频、微波）。局部治疗，如肝内动脉灌注、放射栓塞和腹腔内热化疗，其适应证也得到了明确（肝优势疾病和可切除性腹膜癌病）。在预处理过的患者中开发了新的治疗方法，提高了总生存率并保留了生活质量（regorafenib 和 trifluridine/tipiracil）。最后，免疫检查点抑制剂在 MSI mCRC 中显示出高疗效。
制定法国 mCRC 管理指南是为了帮助在日常临床实践中提供最佳的个体化治疗策略，因为 mCRC 的治疗格局正在变得更加复杂。这些建议正在不断审查和更新。每个病例都必须在多学科团队（MDT）中进行讨论。
