Neoadjuvant therapy for oligometastatic colorectal cancer.

Abstract

Every patient with oligometastatic disease should be discussed within a multidisciplinary team.The intention of treating oligometastatic disease is curative in most cases. Surgical treatment is essential, and can be combined with ablation methods. Oncological criteria that describe the risk of progression/relapse help select patients who benefit most from neoadjuvant/perioperative chemotherapy. For optimal selection of systemic treatment for metastatic colorectal cancer, knowledge of predictive molecular factors is necessary. These include determination of RAS, BRAF and MMR/MSI. The basis of systemic treatment is chemotherapy based on combinations of fluoropyrimidines, oxaliplatin or irinotecan. A special group  includes patients with dMMR/MSI-high tumors, which are very sensitive to the treatment with modern immunotherapy with checkpoint inhibitors. The question of the indication of immunotherapy in the case of resectable metastases has not been resolved yet.