Changes to This Summary (06/05/2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Updated statistics with estimated new cases and deaths for 2014 (cited American Cancer Society as reference 1).
Added text to state that limited data and no level 1 evidence are available to guide patients and physicians about surveillance and management of patients after surgical resection and adjuvant therapy. The American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend specific surveillance and follow-up strategies (cited Meyerhardt et al. and Benson et al. as references 25 and 26, respectively).
Revised text to state that to date, no large-scale randomized trials have documented an overall survival (OS) benefit for standard, postoperative monitoring program.
Added Factors Associated with Recurrence as a new subsection.
Revised text of subsection title to read Neoadjuvant chemotherapy for unresectable liver metastases.
Added text to state that there is no consensus on the best regimen to use to convert unresectable isolated liver metastases to resectable liver metastases.
Revised text of subsection title to read Adjuvant or neoadjuvant chemotherapy for resectable liver metastases.
Revised Adjuvant or neoadjuvant chemotherapy for resectable liver metastases subsection.
Added text to provide evidence about intra-arterial chemotherapy after liver resection and included statistics related to two trials that evaluated hepatic arterial floxuridine in the adjuvant setting after liver resection (cited 1999 Kemeny et al. as reference 43 and level of evidence IiiA and 2002 Kemeny as reference 44).
Added text to state that further studies are required to evaluate this treatment approach and to determine whether more effective systemic combination chemotherapy alone may provide similar results compared with hepatic intra-arterial therapy plus systemic treatment.
Added text to include regorafenib to list of nine active and approved drugs for patients with metastatic colorectal cancer.
Revised text to state that before the availability of cetuximab, panitumumab, bevacizumab, and aflibercept as second-line therapy, second-line chemotherapy with irinotecan in patients treated with 5-FU/LV as first-line therapy demonstrated improved OS when compared with either infusional 5-FU or supportive care.
Added text to state that a retrospective analysis evaluated patients with wild-type KRAS exon 2 status for other KRAS and BRAF mutations. Of the 620 patients who were initially identified as not having a mutation in exon 2 of KRAS, 108 patients were found to have additional RAS mutations and 53 patients were found to have BRAF mutations. In a retrospective analysis, patients without any RAS or BRAF mutations had a longer PFS and OS when assigned to the oxaliplatin, 5-FU and LV (FOLFOX-4) and panitumumab arm than the patients assigned to the FOLFOX-4 arm (cited Douillard et al. as reference 81 and level of evidence 3iiiA).
Revised text to state that patients were randomly assigned in a 2:1 fashion to receive regorafenib or placebo in addition to best supportive care; also updated statistics showing a significant improvement in OS for patients treated with regorafenib (cited Grothey et al. as reference 85).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.