From the Guidelines
Treatment for oligoprogressive Colorectal Cancer (CRC) involves local therapy to control progressive lesions while continuing systemic therapy. This approach is supported by recent guidelines, such as those outlined in the 2023 ESMO clinical practice guideline for diagnosis, treatment, and follow-up of metastatic colorectal cancer 1.
Key Treatment Options
- Continuation of current systemic therapy with local ablative therapies, such as radiofrequency ablation or stereotactic body radiation therapy, to control the progressive lesion 1.
- Switching to a different chemotherapy regimen, which may be considered based on the patient's response to previous treatments and the extent of disease progression.
- Targeted therapies, which can be added to the treatment regimen to enhance its effectiveness.
Local Therapy
Local therapy, including surgery or non-surgical approaches like local tumor treatment (LT), can be used to eradicate limited disease, replace surgery in certain situations, or as a primary or metastasis-specific treatment to halt further dissemination 1. In the context of oligoprogressive disease, LT aims to eliminate non-responding cell clones and enable the continuation of systemic therapy 1.
Systemic Therapy Considerations
The decision to continue or switch systemic therapy should be based on factors such as the patient's overall prognosis, the extent of disease progression, and previous response to treatment. In cases where oligoprogression occurs, induction chemotherapy (ChT) treatment may be considered, with the goal of achieving response or at least disease stabilization, which is a strong predictor of a favorable prognosis 1.
From the Research
Treatment Options for Oligoprogressive Colorectal Cancer (CRC)
- Metastasis-directed radiotherapy (MRT) has been evaluated as a treatment option for oligoprogressive or oligopersistent metastatic colorectal cancer (mCRC) 2.
- MRT may be performed safely in conjunction with systemic treatment to maximize the benefit of systemic therapy and to prolong the time to change to systemic therapy 2.
- Local treatments, such as surgical resection, percutaneous ablation, and stereotactic body radiotherapy, are essential in managing oligometastatic CRC, with the goal of complete eradication of metastases 3.
- Systemic therapy, including chemotherapy and targeted therapy, plays a crucial role in controlling micrometastatic disease and enhancing local treatment effectiveness 3, 4, 5.
- Targeted therapy, such as anti-EGFR and anti-angiogenesis agents, has shown promise in prolonging overall survival for CRC patients 5.
- Current treatment approaches for mCRC include a combination of systemic chemotherapy, targeted therapy, and local treatments, with a focus on identifying targetable subsets of patients 6.
Chemotherapy and Targeted Therapy
- Chemotherapy regimens, such as 5-fluorouracil, leucovorin, and oxaliplatin, and 5-fluorouracil, leucovorin, and irinotecan, are commonly used in the treatment of mCRC 2, 4.
- Targeted therapy, including cetuximab and bevacizumab, has been shown to improve overall survival in CRC patients 5.
- New agents blocking different critical pathways and immune checkpoints are emerging as potential treatment options for CRC 5.