What systemic therapy would you use in T3N1M1 MMR proficient rectal cancer with solitary liver lesion when going for curative intent (chemo>short course RT> resection of primary and liver met)?

Hi,

I think this is an important question. For resectable disease, most data we have is from the EORTC 40983 trial in which FOLFOX was used. For borderline resectable, you could consider FOLFOXIRI based on the OLIVIA trial. That being said, obtaining molecular profiling for this patient is key which ...

Assuming this is a resectable liver lesion, one may consider initial surgery for primary and metastatic focus with adjuvant chemotherapy. Radiation reduces local recurrence only which may not be high risk depending on the rectal lesion.

If proceeding with the TNT approach, there is no compelling rea...

I agree with Drs. @Dr. First Last and @Dr. First Last that there is likely little to no benefit for using the more toxic FOLFOXIRI regimen over FOLFOX +/- biologic as appropriate.

You could also argue for avoiding radiation therapy altogether if you have a sufficient response to FOLFOX in both the l...

There are a few things to consider in this case:

• Make sure MMR testing is done. There’s about a 5% chance the tumor is MMR-deficient (rate depends on location and is highest in right-sided colon cancers)
• Consider pre-treatment liver MRI
• I typically start with systemic therapy in cases like this. If...

If the patient is already resectable as is and response rate is not critical, I would lean towards FOLFOX +/- bevacizumab. Tumor biology would be an important measure as you weigh surgery options. If the patient is very robust or we need a bigger response, I think FOLFOXIRI +/- bev is the right answ...