lec6 Flashcards
Primary treatment for colon cancer appropriate for resection
Resectable non obstructing colon cancer treatment
colectomy with removal of regional lymph nodes
Primary treatment for colon cancer appropriate for resection
Resectable, obstructing colon cancer treatment
1- One-stage colectomy with removal of regional lymph nodes
2- Resection with diversion
3-Diversion
4- Stent
Primary treatment for colon cancer appropriate for resection
Bulky nodal disease colon cancer treatment
neoadjuvant
FOLFOX or CAPEOX
Primary treatment for colon cancer appropriate for resection
Clinical T4b colon cancer treatment
1- FOLFOX or CAPEOX
2- (Nivolumab ± ipilimumab) or pembrolizumab (dMMR/MSI-H)
Locally unresectable or medically inoperable colon cancer treatment
1-Systemic Therapy
2-Infusional 5-FU + RT
3-Capecitabine + RT
Colon Cancer adjuvant treatment accurding to stage
Tis; (T1, N0, M0); (T2, N0, M0)
Observation
Colon Cancer adjuvant treatment accurding to stage
(T3 , N0, M0)
(No high-risk features)
1- Observation
2- capecitabine (6 months)
3- 5-FU/leucovorin (6 months)
Colon Cancer adjuvant treatment accurding to stage
T3, N0, M0 (at high risk for systemic recurrence)
or T4, N0, M0
1-Capecitabine (6 months)
2-5-FU/leucovorin (6months)
3- FOLFOX (6 months)
4-CAPEOX (3 months)
Colon Cancer adjuvant treatment accurding to stage
T1–3, N1 (low-risk stage III)
1-CAPEOX (3 months)
2-FOLFOX (3–6 months)
3-Capecitabine (6 months)
4- 5-FU (6 months)
Colon Cancer adjuvant treatment accurding to stage
(T4, N1–2); (T Any, N2) = (high-risk stage III)
1-CAPEOX (3–6 months)
2-FOLFOX (6months)
3-Capecitabine (6 months)
4- 5-FU (6 months)
which drug is considered as a replacement for fluorouracil in an attempt to improve the safety and ease of administration of the chemotherapy regimen
Capecitabine
What is the most effective approuch to giving fluorouracil
giving Leucovorin prior to fluorouracil
why do we give Preoperative (neoadjuvant) chemoradiation to colon cancer patients
to improve resectability
what is the primary treatment modality for unresectable metastatic colorectal cancer
Chemotherapy
what is the use of surgery and radiation in metastatic Colon cancer
used to manage isolated sites (one place) of
tumor
who is a candidate for multimodality therapy in colon cancer
Patients with resectable metastases
Resectable Metastatic Colorectal Cancer
what is the adjuvant treatment
1- No previous chemotherapy
FOLFOX or CAPEOX (preferred) or Capecitabine or 5-FU/leucovorin.
2-Previous chemotherapy
Observation (preferred for previous oxaliplatin-based therapy).
Systemic therapy ± biologic therapy.
Resectable Metastatic Colorectal Cancer
what is the Treatments used in Hepatic Therapy
1- Drugs: – Floxuridine with dexamethasone and fluorouracil with or without leucovorin.
2- XRT.
3- Cryoablation.
Unresectable Metastatic Colorectal Cancer Primary treatment
if the patient took Previous adjuvant FOLFOX/CAPEOX within past 12 months (1 year) what is the treatment?
Based on gene mutation Only
1- KRAS/NRAS/BRAF WT )wild-type= not mutated gene only:
* FOLFIRI or irinotecan ± bevacizumab
* (FOLFIRI or irinotecan) ± (cetuximab or panitumumab)
2- – dMMR/MSI-H only:
* Nivolumab ± (ipilimumab or pembrolizumab)
3- – BRAF V600E mutation positive:
* Encorafenib + (cetuximab or panitumumab)
Unresectable Metastatic Colorectal Cancer Primary treatment
if Previous adjuvant FOLFOX/CAPEOX >12 months or Previous 5-FU/LV or capecitabine or No previous chemotherapy what is the treatment?
Based on gene mutation and intentsity
If Intensive therapy recommended:
1- FOLFOX or CAPEOX or FOLFIRI or FOLFIRINOX ± bevacizumab.
2- KRAS/NRAS/BRAF WT: FOLFOX or FOLFIRI + (cetuximab or panitumumab).
3-* dMMR/MSI-H only: ([Nivolumab ± ipilimumab] or pembrolizumab)
If Intensive therapy NOT recommended:
1- 5-FU ± leucovorin ± bevacizumab or Capecitabine ± bevacizumab
2- KRAS/NRAS/BRAF WT: Cetuximab or panitumumab
3- dMMR/MSI-H only: Nivolumab or pembrolizumab
4- HER2-amplified and RAS and BRAF WT: Trastuzumab + (pertuzumab or lapatinib).
just Remove ChemoTherapy in non intensive :D
Why do we wait 6 weeks before doing surgery after giving bevacizumab
Because of the bleeding Risk
Mention VEGF Inhibitors
2r zb
1-bevacizumab,
2-ramucirumab,
3-ziv-aflibercept
4-the multikinase inhibitor regorafenib (Limited to 3rd line)
What is the 2nd line treatment for metastatic colon cancer with disease progression on first line treatment
اعكس :]
1- Irinotecan should be considered standard second-line therapy.
2- (FOLFOX) : for patients who received primary treatment with irinotecan plus fluorouracil.
Salvage therapy for metastatic colon cancer
- The combination of oxaliplatin plus fluorouracil and leucovorin (FOLFOX) or (FOLFIRI)
