演題抄録

臓器別シンポジウム

開催概要
開催回
第55回・2017年・横浜
 

大腸癌に対する化学療法

演題番号 : OSY1-5

[筆頭演者]
植竹 宏之:1 
[共同演者]
石川 敏昭:1、石黒 めぐみ:2

1:東京医科歯科大学・大学院・総合外科学、2:東京医科歯科大学・大学院・応用腫瘍学

 

In recent decades, treatment for metastatic colorectal cancer (mCRC) has remarkably progressed with the advent of biological agents. Nowadays the median survival time of mCRC patients is over 30 months. Under such circumstances, it becomes a key issue which biological agent is a preferred treatment, especially for first-line treatment of mCRC patients with RAS wild-type tumor. For unresectable diseases, preferred treatment depends on treatment goal; patients should be treated to seek for maximum shrinkage, or treatment duration. If the former, anti-EGFR mab might be a preferred option in terms of depth of response. If the latter, bevacizumab might be preferred in terms of maintenance therapy. For potentially resectable diseases, such as liver limited diseases, a similar strategy for treatment can be recommended. There is are several types of liver metastases (LM). If LM is bulky and unresectable, a tumor shrinkage is needed so that LM can be converted to be resectable. If LM is disseminated and unresectable, a pathological effect is needed to prevent recurrence after liver resection. If the former, anti-EGFR mab might be preferred and if the latter, bevacizumab might be better, considering characteristics of biological agents.
Postoperative adjuvant chemotherapy is performed after curative resection for colorectal cancer to prevent recurrence and improve patients' prognosis. Because therapeutic outcomes for colorectal cancer are better in Japan than in other countries, adjuvant chemotherapy tailored to be optimal for individual patients should be introduced based on not only evidence from overseas but also the results of Japanese clinical trials. Many questions remain to be verified in clinical trials and other studies, including the merits or otherwise of adjuvant chemotherapy after metastatic resection and whether it should be used for elderly patients. Attention is also focusing on biomarkers for identifying high-risk patients who require adjuvant chemotherapy.

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