Метастатический рак толстой кишки: обновление клинических рекомендаций в 2024 г.

В статье представлены изменения клинических рекомендаций по лечению метастатического рака толстой кишки в 2024 г. Новые положения в клинических рекомендациях дополнены кратким обзором результатов исследований, которые лежат в их основе. Рассмотренные изменения касаются не только системного противоопухолевого лечения, но и хирургии и молекулярно-генетической диагностики. Приведены отличия рекомендаций RUSSCO и Минздрава России. Обсуждается внесение информации по определению клинической пользы дорогостоящих терапевтических опций в отношении применения шкал ESMO-MCBS и RUSSCO-MCBS.

Цель исследования – предоставить обзор информации для широкого круга читателей по планируемым изменениям в клинических рекомендациях, касающихся метастатического рака толстой кишки.

1. Osterlund P., Salminen T., Soveri L.-M. et al. Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): A nationwide prospective intervention study. Lancet Reg Health Eur 2021;3:100049. DOI: 10.1016/j.lanepe.2021.100049

2. Chow F.C., Chok K.S. Colorectal liver metastases: an update on multidisciplinary approach. World J Hepatol 2019;11(2):150–72. DOI: 10.4254/wjh.v11.i2.150

3. Bregni G., Giasafaki P., Leurquin B. et al. 5MO – Individual patient data (IPD) meta-analysis of randomized phase III trials (RP3) of chemotherapy for resectable colorectal cancer liver metastases (CRCLM): EORTC RP-2145. Ann of Oncol 2024:35(Suppl_1):S1–74. DOI: 10.1016/annonc/annonc1477

4. Rahbari N.N., Reissfelder C., Schulze-Bergkamen H. et al. Adjuvant therapy after resection of colorectal liver metastases: the predictive value of the MSKCC clinical risk score in the era of modern chemotherapy. BMC Cancer 2014;14:174. DOI: 10.1186/1471-2407-14-174

5. Ros J., Salva F., Dopazo C. et al. Liver transplantation in metastatic colorectal cancer: are we ready for it? Br J Cancer 2023;128(10):1797–806. DOI: 10.1038/s41416-023-02213-1

6. Sasaki K., Ruffolo L.I., Kim M.H. et al. The current state of liver transplantation for colorectal liver metastases in the United States: A call for standardized reporting. Ann Surg Oncol 2023;30(5):2769–77. DOI: 10.1245/s10434-023-13147-6

7. Adam R., Piedvache C., Chiche L. et al. Liver transplantation plus chemotherapy versus chemotherapy alone in patients with permanently unresectable colorectal liver metastases (TransMet): results from a multicentre, open-label, prospective, randomised controlled trial. Lancet 2024;404(10458):1107–18. DOI: 10.1016/S0140-6736(24)01595-2

8. Цуканов А.С., Шелыгин Ю.А., Семенов Д.А. и др. Синдром Линча. Современное состояние проблемы. Медицинская генетика 2017;16(2):11–8.

9. Ciardiello D., Bielo L.B., Napolitano S. et al. Comprehensive genomic profiling by liquid biopsy captures tumor heterogeneity and identifies cancer vulnerabilities in patients with RAS/BRAFV600E wild-type metastatic colorectal cancer in the CAPRI 2-GOIM trial. Ann Oncol 2024:S0923-7534(24)03914-0. DOI: 10.1016/j.annonc.2024.08.2334

10. Федянин М.Ю., Эльснукаева Х.Х.-М., Демидова И.А. и др. Колоректальный рак с мутацией в гене BRAF в Российской Федерации: эпидемиология и клинические особенности. Результаты многоцентрового исследования. Медицинский совет 2021;(S4):52–63. DOI: 10.21518/2079-701X-2021-4S-52-63

11. Kotani D., Bando H., Taniguchi H. et al. Efficacy and safety of combination therapy with binimetinib, encorafenib, and cetuximab for BRAF non-V600E mutated metastatic colorectal cancer: Results from a phase 2 BIG BANG trial (EPOC1703). J Clin Oncol 2024;42(16_suppl):3585. DOI: 10.1200/JCO.2024.42.16_suppl.3585

12. Mulkidjan R.S., Saitova E.S., Preobrazhenskaya E.V. et al. ALK, ROS1, RET and NTRK1-3 gene fusions in colorectal and noncolorectal microsatellite-unstable cancers. Int J Mol Sci 2023;24(17):13610. DOI: 10.3390/ijms241713610

13. Wang F., Zhao Q., Wang Y.-N. et al. Evaluation of POLE and POLD1 mutations as biomarkers for immunotherapy outcomes across multiple cancer types. JAMA Oncol 2019;5(10):1504–6. DOI: 10.1001/jamaoncol.2019.2963.

14. Shiu K., André T., Kim T.W. et al. Pembrolizumab versus chemotherapy in microsatellite instability-high (MSI-H)/mismatch repair-deficient (dMMR) metastatic colorectal cancer (mCRC): 5-year follow-up of the randomized phase III KEYNOTE-177 study. Annals of Oncology 2023;34(suppl_2):S1254–335. DOI: 10.1016/S0923-7534(23)04149-2

15. Lenz H.-J., Lonardi S., Elez E. et al. Nivolumab (NIVO) plus ipilimumab (IPI) vs chemotherapy (chemo) as first-line (1L) treatment for microsatellite instability-high/mismatch repairdeficient (MSI-H/dMMR) metastatic colorectal cancer (mCRC): Expanded efficacy analysis from CheckMate 8HW. J Clin Oncol 2024;42(16_suppl). DOI: 10.1200/JCO.2024.42.16_suppl.3503

16. Chen M., Wang Z., Liu Z. et al. PD-1/PD-L1 Inhibitor plus chemotherapy versus PD-1/PD-L1 inhibitor in microsatellite instability gastrointestinal cancers: A multicenter retrospective study. JCO Precis Oncol 2023:7:e2200463. DOI: 10.1200/PO.22.00463

17. de Langen A.J., Johnson M.L., Mazieres J. et al. Sotorasib versus docetaxel for previously treated non-small-cell lung cancer with KRASG12C mutation: a randomised, open-label, phase 3 trial. Lancet 2023;401(10378):733–46. DOI: 10.1016/S0140-6736(23)00221-0

18. Fakih M.G., Salvatore L., Esaki T. et al. Sotorasib plus panitumumab in refractory colorectal cancer with mutated KRASG12C. N Engl J Med 2023;389(23):2125–39. DOI: 10.1056/NEJMoa2308795

19. Siena S., Yamaguchi K., Rodriguez J.C.R. et al. Sotorasib (soto), panitumumab (pani) and FOLFIRI in the first-line (1L) setting for KRASG12C–mutated metastatic colorectal cancer (mCRC): Safety and efficacy analysis from the phase Ib CodeBreaK 101 study. Annals of Oncol 2024;35(suppl_2):S428–81. DOI: 10.1016/annonc/annonc1588

20. Yaeger R., Weiss J., Pelster M.S. et al. Adagrasib with or without cetuximab in colorectal cancer with mutated KRASG12C. N Engl J Med 2023;388(1):44–54. DOI: 10.1056/NEJMoa2212419

21. Raghav K., Siena S., Takashima A. et al. Trastuzumab deruxtecan in patients with HER2-positive advanced colorectal cancer (DESTINY-CRC02): primary results from a multicentre, randomised, phase 2 trial. Lancet Oncol 2024;25(9):1147–62. DOI: 10.1016/S1470-2045(24)00380-2

22. Tabernero J., Grothey A., Van Cutsem E. et al. Encorafenib plus cetuximab as a new standard of care for previously treated BRAF V600E-mutant metastatic colorectal cancer: updated survival results and subgroup analyses from the BEACON study. J Clin Oncol 2021;39(4):273–84. DOI: 10.1200/JCO.20.02088

23. Kopetz S., Yoshino T., Kim T.W. et al. BREAKWATER safety leadin (SLI): Encorafenib + cetuximab (EC) ± chemotherapy for firstline (1L) treatment (tx) of BRAF V600E-mutant (BRAF V600E) metastatic colorectal cancer (mCRC). J Clin Oncol 2022; 40(4_suppl):134. DOI: 10.1200/JCO.2022.40.4_suppl.134

24. Cherny N.I., Dafni U., Bogaerts J. et al. ESMO-magnitude of clinical benefit scale version 1.1. Ann Oncol 2017;28(10):2340–66. DOI: 10.1093/annonc/mdx310.

25. Krech R., Peters S., Kroemer H. et al. Tobacco cessation and the role of ESMO and medical oncologists: addressing the specific needs of cancer patients in times of the COVID-19 pandemic. ESMO Open 2023;8(3):101579. DOI: 10.1016/j.esmoop.2023.101579

26. Shields P.G., Bierut L., Arenberg D. et al. Smoking cessation, version 3.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2023;21(3):297–322. DOI: 10.6004/jnccn.2023.0013

27. Choy K.T., Lam K., Kong J.C. Exercise and colorectal cancer survival: an updated systematic review and meta-analysis. Int J Colorectal Dis 2022;37(8):1751–8. DOI: 10.1007/s00384-022-04224-5

28. Agirre-Elordui S., Fernández-Landa J., Olasagasti-Ibargoien J. et al. Physical activity maintenance in colorectal cancer survivors after an exercise intervention applying behaviour change techniques: a systematic review and meta-analysis. J Cancer Surviv 2024. DOI: 10.1007/s11764-024-01654-8

29. Walter V., Jansen L., Hoffmeister M., Brenner H. Smoking and survival of colorectal cancer patients: systematic review and meta-analysis. Ann Oncol 2014;25(8):1517–25. DOI: 10.1093/annonc/mdu040

30. Alwers E., Carr P.R., Banbury B. Smoking behavior and prognosis after colorectal cancer diagnosis: a pooled analysis of 11 studies. JNCI Cancer Spectr 2021;5(5):p.pkab077. DOI: 10.1093/jncics/pkab077

31. Badiani S., Diab J., Woodford E.R. Impact of preoperative smoking on patients undergoing right hemicolectomies for colon cancer. Langenbecks Arch Surg 2022;407(5):2001–9. DOI: 10.1007/s00423-022-02486-9. Erratum in: Langenbecks Arch Surg 2022;407(8):3889. DOI: 10.1007/s00423-022-02528-2

32. Park E.R., Perez G.K., Regan S. et al. Effect of sustained smoking cessation counseling and provision of medication vs shorter-term counseling and medication advice on smoking abstinence in patients recently diagnosed with cancer: A randomized clinical trial. JAMA 2020;324(14):1406–18. DOI: 10.1001/jama.2020.14581

33. Scholten P.R., Stalpers L.J., Bronsema I. et al. The effectiveness of smoking cessation interventions after cancer diagnosis: a systematic review and meta-analysis. J Cancer Policy 2024;39:100463. DOI: 10.1016/j.jcpo.2023.100463

34. Haussmann H.J., Fariss M.W. Comprehensive review of epidemiological and animal studies on the potential carcinogenic effects of nicotine per se. Critical reviews in toxicology 2016;46(8):701–34. DOI: 10.1080/10408444.2016.1182116

35. Hartmann-Boyce J., McRobbie H., Butler A.R. et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2022;9:CD010216. DOI: 10.1002/14651858.CD010216.pub5

36. Lindson N., Butler A.R., McRobbie H. et al. Electronic cigarettes for smoking cessation. Cochrane Database of Syst Rev 2024;1(1):CD010216. DOI: 10.1002/14651858.CD010216.pub8

37. Ansari S.M., Hession P.S., David M. et al. Impact of switching from cigarette smoking to tobacco heating system use on biomarkers of potential harm in a randomized trial. Biomarkers 2024;29(5):298–314. DOI: 10.1080/1354750X.2024.2358318

38. Hatsukami D.K., Benowitz N.L., Rennard S.I. et al. Biomarkers to assess the utility of potential reduced exposure tobacco products. Nicotine Tob Res 2006;8(4):600–22. DOI: 10.1080/14622200600858166

39. Xue J., Yang S., Seng S. Mechanisms of cancer induction by tobacco-specific NNK and NNN. Cancers (Basel) 2014;6(2):1138–56. DOI: 10.3390/cancers6021138

40. Yuan J.M., Butler L.M., Stepanov I., Hecht S.S. Urinary tobacco smoke-constituent biomarkers for assessing risk of lung cancer. Cancer Res 2014;74(2):401–11. DOI: 10.1158/0008-5472.CAN-13-3178

41. Hoang T., Kim H., Kim J. Dietary intake in association with allcause mortality and colorectal cancer mortality among colorectal cancer survivors: A systematic review and meta-analysis of prospective studies. Cancers (Basel) 2020;12(11):3391. DOI: 10.3390/cancers12113391

42. Chan D.S.M., Cariolou M., Markozannes G. et al. Post-diagnosis dietary factors, supplement use and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024;155(3): 445–70. DOI: 10.1002/ijc.34906