This review covers the latest data on antiangiogenic agents used in patients with colorectal cancer. In this article, we describe drugs that have already been included into therapy regimens for colorectal cancer and vascular endothelial growth factor (VEGF) inhibitors that have been approved for other indications. Targeted drugs with a similar mechanism of action that are currently in clinical trials are discussed separately. VEGF-inhibitors are one of the main groups of targeted drugs for colorectal cancer with an acceptable toxicity profile, which can be used both in combination with chemotherapeutic agents and as maintenance treatment. Moreover, these drugs are not dependent on mutational status, which is a significant advantage.

Colon cancer is known to be resistant to immunotherapy; however, during the last few years, researchers managed to identify a subgroup of patients that response to anti-PD-1 therapy. This encouraged molecular biologists, immunologists, and clinical oncologists to reconsider the role of immunotherapy for colon cancer. A substantial number of studies devoted to this problem have been published so far, which allowed us to prepare a literature review. This review covers the main trends in immunotherapy of colon cancer, including prognostic value of tumor-infiltrating lymphocytes, efficacy of immune checkpoint inhibitors, bispecific monoclonal antibodies, and antitumor vaccines, as well as transformation of non-inflammatory cancer phenotype into the inflammatory one.

Background. In the last decades laparoscopic technologies have been actively implemented for rectal cancer surgery, however randomized control trials have not demonstrated overt advantages of laparoscopic technique comparing to open surgery. The improvement of quality of life is expected to be one of advantages of laparoscopic approach. Objective: a prospective study of the dependence of the quality of life on the type of operative access (open or laparoscopic) in patients with rectal cancer after low anterior resection of the rectum. Materials and methods. There were 30 patients in the study: 20 of them were operated laparoscopically and 10 were underwent open surgery. The current versions of the general questionnaire EORTC QLQ-C30 and the special module for patients with colorectal cancer EORTC QLQ-CR29 were used in the study, that were filled on the day before the surgery and also on days 3, 7 and 60 after the surgery. Results. In the first 7 days after laparoscopic operations patients had less frequent dysuric dysfunctions (p = 0.047), less pain syndrome (p = 0.0005) and flatulence (p = 0.007) comparing to open operations. At 60 days after surgery patients that were operated laparoscopically were satisfied by their appearance more often (p = 0.047) than patients after open surgery, more rarely had anxiety (p = 0.007) and discomfort in the area of postoperative wounds (p = 0.079). Conclusion. It has been proven that laparoscopic surgery of rectal cancer evidently improves quality of life in postoperative period.

Objective: to determine the efficacy of 2 oxaliplatin-based chemotherapy regimens (FOLFOX and XELOX) for metastatic colorectal cancer (CRC) depending on the KRAS mutation status and primary tumor location. Materials and methods. We performed retrospective analysis of the data on patients with metastatic CRC taken from a prospective database. We included patients with known KRAS mutation status that received either FOLFOX or XELOX without targeted drugs. Progression-free survival (PFS) was used as a main criterion in estimating treatment efficacy. Results. The inclusion criteria were met by 157 patients. The FOLFOX regimen was more effective in patients with wild-type KRAS CRC: median PFS was 10 months versus 8 months in the XELOX group (hazard ratio (HR) = 0.7; 95 % confidence interval (CI) 0.4–1.2; р = 0.1). However, we observed no significant differences in median life expectancy between these groups: it was 37 and 38 months respectively (HR = 1.1; 95 % CI 0.6–2.1; p = 0.6). Similar trends were observed in patients bearing KRAS mutations: median PFS in the FOLFOX group was 9 months vs 5 months in the XELOX group (HR = 0.6; 95 % CI 0.3–1.2; р = 0.1; p value by Breslow – Day test = 0.04). No differences in median life expectancy between these groups were observed: 33 and 23 months respectively (HR = 0.8; 95 % CI 0.4–1.6; p = 0.5). Conclusion. We failed to find an association between the KRAS mutation status and response to a particular chemotherapy regimen. We found that patients with metastatic CRC receiving the FOLFOX regimen were more likely to achieve objective responses and demonstrated higher median PFS than patients on the XELOX regimen.

Objective: to evaluate the long-term outcomes of combined treatment with polyradiomodification in patients with rectal cancer depending on the grade of therapeutic pathomorphosis. Materials and methods. The study included 241 patients that received combined treatment with polyradiomodification for T2–3N0–2M0 resectable rectal adenocarcinoma of varying degree of differentiation. All patients received a course of preoperative radiation therapy (5 × 5 Gy) combined with capecitabine and metronidazole (in a polymer composition at a dose of 10 g/m2 per rectum) on days 3 and 5. Some patients additionally underwent local hyperthermia. Four different polyradiomodification regimens were used. We assessed the frequency of relapses, metastases, and relapse-free survival depending on the grade of therapeutic pathomorphosis and cancer stage. Results. Median follow-up time was 48.5 months. One patient with stage III therapeutic pathomorphosis had relapse. Distant metastases were diagnosed in 35 (19.7 %) out of 178 participants with grade 0–II therapeutic pathomorphosis and 4 (6.3 %) out of 63 participants with grade III therapeutic pathomorphosis; the difference between these groups was statistically significant (p = 0.01). No metastases were observed in patients with grade IV therapeutic pathomorphosis. Among patients with T2–3N1–2M0 rectal cancer, the five-year relapse-free survival was higher in the group with grade III–IV therapeutic pathomorphosis compared to the group with grade 0–II pathomorphosis: 95.7 % versus 56.7 % (p = 0.00422). Conclusion. Our treatment strategy ensures good local disease control. Patients with grade III–IV therapeutic pathomorphosis have significantly lower frequency of relapses and metastases and better relapse-free survival.

Background. Despite the fact that treatment of metastatic colorectal cancer (mCRC) has undergone major advances in recent decades, long-term results remain unsatisfactory. Therefore, the development of new first-line therapeutic regimens for mCRC is an important challenge in current oncology. Objective: to assess the efficacy and safety of a novel therapeutic regimen containing irinotecan (Iri) + oxaliplatin (Oxa) + 5-fluorouracil (5-FU) in the first-line treatment of mCRC. Materials and methods. This prospective study included patients with mCRC that have never received therapy for disseminated tumors. All study participants were treated with a new first-line therapeutic regimen, developed by the Department of Chemotherapy and Combined Treatment of Malignant Tumors, Research Institute of Clinical Oncology, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russia. This regimen includes a combination of Iri (100 mg/m2 body surface given as a 90-minute intravenous (IV) infusion on days 1 and 15) + Oxa (65 mg/m2 surface given as a 120-minute IV infusion on days 1 and 15) + 5-FU (200 mg/m2 /day, 14-days continuous IV infusion), than the patients had a treatment-free interval of 2 weeks followed by a new course starting from day 29. Results. In patients with multiple large visceral metastases, disease control (complete regression + partial regression + disease stabilization for >6 months) was achieved in 95 % of cases. The objective response rate (complete regression + partial regression) was 85 %. Median progression-free survival reached 10.8 ± 2.13 months (95 % confidence interval 6.62–14.98). Median overall survival in 20 patients has not yet been reached at a median follow-up time of 17.3 ± 2.54 months (95 % confidence interval 12.31–22.29). One-year overall survival was 88.9 %. During the study, we observed toxic effects typical of Iri, Oxa and 5-FU; in most of the cases, it was grade 1–2 toxicity. Grade 3 toxicity manifested primarily as neutropenia (14 % of courses). Neither grade 4 toxicity, nor episodes of febrile neutropenia were observed. None of the patients had to discontinue treatment due to unacceptable toxic effects. Conclusion. Our findings suggest high efficacy and safety of the new first-line triple-combination therapy with Iri + Oxa + 5-FU in patients with mCRC and unfavourable disease characteristics.

The article discusses the tactics and results of treatment of locally advanced colon cancer. We consider the reasonability of multivisceral colon resections in locally advanced colon cancer. The clinical case of locally advanced cancer of the left half of the colon, which got combined treatment, is presented.