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Inoperable de novo metastatic colorectal cancer with primary tumour in situ: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre)

  • Authors:
    • Ruba A. Hamed
    • Sam Marks
    • Helen Mcelligott
    • Roshni Kalachand
    • Hawa Ibrahim
    • Said Atyani
    • Greg Korpanty
    • Nemer Osman
  • View Affiliations / Copyright

    Affiliations: Department of Oncology, Mid‑Western Cancer Centre, University Hospital Limerick, Limerick V94 F858, Ireland, Palliative Department, St. Francis Hospice, Dublin 5 D05 T9K8, Ireland, Radiology Department, University Hospital Limerick, Limerick V94 F858, Ireland
    Copyright: © Hamed et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 40
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    Published online on: December 21, 2021
       https://doi.org/10.3892/mco.2021.2472
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Abstract

Systemic therapy is the mainstay of treatment for de novo metastatic colorectal cancer (mCRC). Heterogeneity between primary tumours and metastases may lead to discordant responses to systemic therapy at these sites. The aim of the present study was to examine these discrepancies and to evaluate the rates of complications arising from the primary tumour and the strategies employed to manage these complications. Electronic medical records were screened for patients eligible for data analysis between January 1st, 2014 and December 31st, 2019. All patients diagnosed with de novo mCRC with primary tumour in situ at the time of initial systemic therapy were included in data analysis. Responses in primary tumour and metastatic sites (according to the Response Evaluation Criteria In Solid Tumours v1.1), discrepancies in these responses and rates of complications arising from primary tumours were assessed along with patient, pathological or molecular factors that may be associated with these discrepant responses or primary tumour complications. A total of 50 patients were identified (median age, 62 years). Right‑colon, left‑colon and rectal primary tumours comprised 34, 44 and 22% of CRC cases, respectively. All patients received 5‑fluorouracil‑based chemotherapy (either alone or in combination with oxaliplatin or irinotecan). Disease response (DR), stable disease (SD) and progressive disease (PD) were observed as the first response to systemic therapy in 24, 62 and 12% of primary tumours and in 36, 18 and 44% of metastatic sites, respectively. Only 36% of patients demonstrated concordant responses between the primary tumours and metastases, while the remaining 62% demonstrated discordant responses between the primary tumour and distant metastases (22% had DR with SD; 36% had DR or SD with PD; and 4% had PD with SD in the primary tumour and metastases, respectively). Restaging images were not available for 2% of the patients. Approximately 30% of patients developed complications from primary tumours, including bowel obstruction (6.12%), perforation (6%), rectal pain (6%) and rectal bleeding (10%). Approximately 10% of patients underwent palliative stoma creation. Additionally, 12% required palliative radiotherapy to the primary tumour (due to localized complications arising from the tumour). Discordant responses to systemic therapy between primary tumours and metastases occurred in 60% of patients with de novo mCRC (with primary tumour in situ at the time of first systemic therapy). The observations of the present study have potential implications for molecular tissue analysis to help guide systemic therapy. Tissue from metastatic sites may be preferable to confirm biomarker status in mCRC based on this study.
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1 

Bray F, Ferlay J, Soerjomatarum I, Siegal RL, Torre LA and Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 68:394–424. 2018.PubMed/NCBI View Article : Google Scholar

2 

Clancy C, Burke JP, Barry M, Kalady MF and Calvin Coffey J: A meta-analysis to determine the effect of primary tumour resection for stage IV colorectal cancer with unresectable metastases on patient survival. Annals Surg Oncol. 21:3900–3908. 2014.PubMed/NCBI View Article : Google Scholar

3 

Kim CW, Baek JH, Choi GS, Yu CS, Kang SB, Park WC, Lee BH, Kim HR, Oh JH, Kim JH, et al: The role of primary tumour resection in the colorectal cancer patients with asymptomatic, synchronous unresectable metastasis: Study protocol for a randomized control trial. Trials. 17(34)2016.PubMed/NCBI View Article : Google Scholar

4 

Tan WJ, Patil S, Guillem JG, Paty PB, Weiser MR, Nash GM, Smith JJ, Pappou EP, Wei IH and Garcia-Aguilar J: Primary Tumour-related complications and salvage outcomes in patients with metastatic rectal cancer and an untreated primary tumour. Dis Colon Rectum. 64:45–52. 2021.PubMed/NCBI View Article : Google Scholar

5 

de Mestier L, Manceau G, Neuzillet C, Bachet JB, Spano JP, Kianmanesh R, Vaillant JC, Bouché O, Hannoun L and Karoui M: Primary tumour resection in colorectal cancer with unresectable synchronous metastases: A review. World J Gastrointest Oncol. 6:156–169. 2014.PubMed/NCBI View Article : Google Scholar

6 

Machover D: A comprehensive review of 5-fluorouracil and leucovorin in patients with metastatic colorectal carcinoma. Cancer. 8:1179–1187. 1997.PubMed/NCBI View Article : Google Scholar

7 

Kurkjian C and Kummar S: Advances in the treatment of metastatic colorectal cancer. Am J Ther. 16:412–420. 2009.PubMed/NCBI View Article : Google Scholar

8 

Leicher LW, de Graaf JC, Coers W, Tascilar M and de Groot JWB: Tolerability of capecitabine monotherapy in metastatic colorectal cancer: A real-world study. Drugs R D. 17:117–124. 2017.PubMed/NCBI View Article : Google Scholar

9 

Fujita K, Kubota Y, Ishida H and Sasaki Y: Irinotecan, a key chemotherapeutic drug for metastatic colorectal cancer. World J Gastroenterol. 21:12234–12248. 2015.PubMed/NCBI View Article : Google Scholar

10 

Comella P, Casaretti R, Sandomenico C, Avallone A and Franco L: Role of oxaliplatin in the treatment of colorectal cancer. Ther Clin Risk Manag. 5:229–238. 2009.PubMed/NCBI View Article : Google Scholar

11 

Fornasier G, Francescon S and Baldo P: An update of efficacy and safety of cetuximab in metastatic colorectal cancer: A narrative review. Adv Ther. 35:1497–1509. 2018.PubMed/NCBI View Article : Google Scholar

12 

Battagin F, Puccini A, Djaballah SA and Lenz HJ: The impact of panitumumab treatment on survival and quality of life in patients with RAS wild-type metastatic colorectal cancer. Cancer Manag Res. 11:5911–5924. 2019.PubMed/NCBI View Article : Google Scholar

13 

Rosen LS, Jacobs IA and Burkes RL: Bevacizumab in colorectal cancer: Current role in treatment and the potential of biosmiliars. Target Oncol. 12:599–610. 2017.PubMed/NCBI View Article : Google Scholar

14 

Verdaguer H, Tebernero J and Macarulla T: Ramucirumab in metastatic colorectal cancer: Evidence to date and place in therapy. Ther Adv Med Oncol. 8:230–242. 2016.PubMed/NCBI View Article : Google Scholar

15 

Yoshihiro T, Kusaba H, Makiyama A, Kobayashi K, Uenomachi M, Ito M, Doi Y, Mitsugi K, Aikawa T, Takayoshi K, et al: Efficacy and safety of ramucirumab plus modified FOLFIRI for metastatic colorectal cancer. Int J Clin Oncol. 24:508–515. 2019.PubMed/NCBI View Article : Google Scholar

16 

Braun MS, Adab F, Bradley C, McAdam K, Thomas G, Wadd NJ, Rea D, Philips R, Twelves C, Bozzino J, et al: Modified de Gramont with oxaliplatin in the first-line treatment of advanced colorectal cancer. Br J Cancer. 89:1155–1158. 2003.PubMed/NCBI View Article : Google Scholar

17 

de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, et al: Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 18:2938–2947. 2000.PubMed/NCBI View Article : Google Scholar

18 

Guo Y, Xiong BH, Zhang T, Cheng Y and Ma L: XELOX vs. FOLFOX in metastatic colorectal cancer: An updated meta-analysis. Cancer Invest. 34:94–104. 2016.PubMed/NCBI View Article : Google Scholar

19 

Cassidy J, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, Koski S, Rittweger K, Gilberg F and Saltz L: XELOX vs FOLFOX-4 as first-line therapy for metastatic colorectal cancer: NO16966 updated results. Br J Cancer. 105:58–64. 2011.PubMed/NCBI View Article : Google Scholar

20 

Saltz LB, Douillard JY, Pirotta N, Alakl M, Gruia G, Awad L, Elfring GL, Locker PK and Miller LL: Irinotecan plus fluorouracil/leucovorin for metastatic colorectal cancer: A new survival standard. Oncologist. 6:81–91. 2001.PubMed/NCBI View Article : Google Scholar

21 

Tournigard C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, Quinaux E, Couteau C, Buyse M, Ganem G, et al: FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. J Clin Oncol. 22:229–237. 2004.PubMed/NCBI View Article : Google Scholar

22 

Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Lerchenmüller C, Kahl C, Seipelt G, et al: FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer FIRE-3): A randomised, open-label, phase 3 trial. Lancet Oncol. 15:1065–1075. 2014.PubMed/NCBI View Article : Google Scholar

23 

Price TJ: Modified XELIRI (capecitabine plus irinotecan) for metastatic colorectal cancer. Lancet Oncol. 19:587–589. 2018.PubMed/NCBI View Article : Google Scholar

24 

Yaffee P, Osipov A, Tan C, Tuli R and Hendifar A: Review of systemic therapies for locally advanced and metastatic rectal cancer. J Gastrointest Oncol. 6:185–200. 2015.PubMed/NCBI View Article : Google Scholar

25 

Suzuki K, Takaharu K, Muto Y, Ichida K, Fukui T, Takayama Y, Tsujinaka S, Sasaki J, Horie H, Kawamura YJ, et al: XELIRI regimen plus continuous treatment with bevacizumab is well-tolerated and effective in metastatic colorectal cancer patients in a second-line setting involving the sequential administration of XELOX and XELIRI. Mol Clin Oncol. 2:827–832. 2014.PubMed/NCBI View Article : Google Scholar

26 

Kawai S, Takeshima N, Hayasaka Y, Notsu A, Yamazaki M, Kawabata T, Yamazaki K, Mori K and Yasui H: Comparison of irinotecan and oxaliplatin as the first-line therapies for metastatic colorectal cancer: A meta-analysis. BMC Cancer. 21(116)2021.PubMed/NCBI View Article : Google Scholar

27 

Marschner N, Arnold D, Engel E, Hutzschenreuter U, Rauh J, Freier W, Hartmann H, Frank M and Jänicke M: Oxaliplatin-based first-line chemotherapy is associated with improved overall survival compared to first-line treatment with irinotecan-based chemotherapy in patients with metastatic colorectal cancers-Results from a prospective cohort study. Clin Epidemiol. 7:295–303. 2015.PubMed/NCBI View Article : Google Scholar

28 

Colucci G, Gebbia V, Paoletti G, Giuliani F, Caruso M, Gebbia N, Cartenì G, Agostara B, Pezzella G, Manzione L, et al: Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: A multicenter study of the Gruppo Oncologico Dell'Italia meridionale. J Clin Oncol. 23:4866–4875. 2005.PubMed/NCBI View Article : Google Scholar

29 

Aparicio T, Desramé J, Lecomte T, Mitry E, Belloc J, Etienney I, Montembault S, Vayre L, Locher C, Ezenfis J, et al: Oxaliplatin- or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly. Br J Cancer. 89:1439–1444. 2003.PubMed/NCBI View Article : Google Scholar

30 

André T, Afchain P, Barrier A, Blanchard P, Larsen AK, Tournigand C, Louvet C and de Gramont A: Current status of adjuvant therapy for colon cancer. Gastrointest Cancer Res. 1:90–97. 2007.PubMed/NCBI

31 

Patel K, Anthoney DA, Crellin AM, Sebag-Montefiore D, Messruther J and Seymour MT: Weekly 5-fluorouracil and leucovorin: Achieving lower toxicity with higher dose-intensity in adjuvant chemotherapy after colorectal cancer resection. Ann Oncol. 15:568–573. 2004.PubMed/NCBI View Article : Google Scholar

32 

Schippinger W, Samonigg H, Schaberl-Moser R, Greil R, Thödtmann R, Tschmelitsch J, Jagoditsch M, Steger GG, Jakesz R, Herbst F, et al: A prospective randomised phase III trial of adjuvant chemotherapy with 5-fluorouracil and leucovorin in patients with stage II colon cancer. Br J Cancer. 97:1021–1027. 2007.PubMed/NCBI View Article : Google Scholar

33 

Fotheringham S, Mozolowski GA, Murray EMA and Kerr DJ: Challenges and solutions in patient treatment strategies for stage II colon cancer. Gastroenterol Rep (Oxf). 7:151–161. 2019.PubMed/NCBI View Article : Google Scholar

34 

Twelves C, Wong A, Nowacki MP, Abt M, Burris H III, Carrato A, Cassidy J, Cervantes A, Fagerberg J, Georgoulias V, et al: Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med. 352:2696–2704. 2005.PubMed/NCBI View Article : Google Scholar

35 

Cassidy J, Twelves C, Van Cutsem E, Hoff P, Bajetta E, Boyer M, Bugat R, Burger U, Garin A, Graeven U, et al: First-line oral capecitabine therapy in metastatic colorectal cancer: A favorable safety profile compared with intravenous 5-fluorouracil/leucovorin. Ann Oncol. 13:566–575. 2002.PubMed/NCBI View Article : Google Scholar

36 

Rizzo A, Nannini M, Astolfi A, Indio V, De Iaco P, Perrone AM, De Leo A, Incorvaia L, Di Scioscio V and Pantaleo MA: Impact of chemotherapy in the adjuvant setting of early stage uterine leiomyosarcoma: A systematic review and updated meta-analysis. Cancers (Basel). 12(1899)2020.PubMed/NCBI View Article : Google Scholar

37 

Rosales J and Leong LA: Chemotherapy for metastatic colorectal cancer. J Natl Compr Canc Netw. 3:525–529. 2005.PubMed/NCBI View Article : Google Scholar

38 

Mayer RJ, Van Cutsem E, Falcone A, Yoshino T, Garcia-Carbonero R, Mizunuma N, Yamazaki K, Shimada Y, Tabernero J, Komatsu Y, et al: Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 372:1909–1919. 2015.PubMed/NCBI View Article : Google Scholar

39 

Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, Humblet Y, Bouché O, Mineur L, Barone C, et al: Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): An international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 381:303–312. 2013.PubMed/NCBI View Article : Google Scholar

40 

Tonini G, Imperatori M, Vincenzi B, Frezza AM and Santini D: Rechallenge therapy and treatment holiday: Different strategies in management of metastatic colorectal cancer. J Exp Clin Cancer Res. 32(92)2013.PubMed/NCBI View Article : Google Scholar

41 

Bekaii-Saab T, Kim R, Kim TW, O'Connor JM, Strickler JH, Malka D, Sartore-Bianchi A, Bi F, Yamaguchi K, Yoshino T and Prager GW: Third- or Later-line therapy for metastatic colorectal cancer: Reviewing best practice. Clin Colorectal Cancer. 18:e117–e129. 2019.PubMed/NCBI View Article : Google Scholar

42 

Kopetz S, Grothey A, Yaeger R, Van Cutsem E, Desai J, Yoshino T, Wasan H, Ciardiello F, Loupakis F, Hong YS, et al: Encorafenib, Binimetinib, and cetuximab in BRAF V600E-mutated colorectal cancer. N Engl J Med. 381:1632–1643. 2019.PubMed/NCBI View Article : Google Scholar

43 

Biller LH and Schrag D: Diagnosis and treatment of metastatic colorectal cancer: A review. JAMA. 325:669–685. 2021.PubMed/NCBI View Article : Google Scholar

44 

Overman MJ, McDermott R, Leach JL, Lonardi S, Lenz HJ, Morse MA, Desai J, Hill A, Axelson M, Moss RA, et al: Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): An open-label, multicentre, phase 2 study. Lancet Oncol. 18:1182–1191. 2017.PubMed/NCBI View Article : Google Scholar

45 

Smith KM and Desai J: Nivolumab for the treatment of colorectal cancer. Expert Rev Anticancer Ther. 18:611–618. 2018.PubMed/NCBI View Article : Google Scholar

46 

André T, Shiu KK, Kim TW, Jensen BV, Jensen LH, Punt C, Smith D, Garcia-Carbonero R, Benavides M, Gibbs P, et al: Pembrolizumab in microsatellite-instability-high advanced colorectal cancer. N Engl J Med. 383:2207–2218. 2020.PubMed/NCBI View Article : Google Scholar

47 

Overman MJ, Lonardi S, Wong KYM, Lenz HJ, Gelsomino F, Aglietta M, Morse MA, Van Cutsem E, McDermott R, Hill A, et al: Durable clinical benefit with nivolumab plus Ipilimumab in DNA mismatch Repair-Deficient/Microsatellite instability-high metastatic colorectal cancer. J Clin Oncol. 36:773–779. 2018.PubMed/NCBI View Article : Google Scholar

48 

Zheng Z, Yu T, Zhao X, Gao X, Zhao Y and Liu G: Intratumour heterogeneity: A new perspective on colorectal cancer research. Cancer Med. 9:7637–7645. 2020.PubMed/NCBI View Article : Google Scholar

49 

Losi L, Baisse B, Bouzourene H and Benhattar J: Evolution of intratumoural genetic heterogeneity during colorectal cancer progression. Carcinogenesis. 26:916–922. 2005.PubMed/NCBI View Article : Google Scholar

50 

Molinari C, Marisi G, Passardi A, Matteucci L, De Maio G and Ulivi P: Heterogeneity in colorectal cancer: A challenge for personalized medicine? Int J Mol Sci. 19(3733)2018.PubMed/NCBI View Article : Google Scholar

51 

Buikhuisen JY, Torang A and Medema JP: Exploring and modelling colon cancer inter-tumour heterogeneity: Opportunities and challenges. Oncogenesis. 9(66)2020.PubMed/NCBI View Article : Google Scholar

52 

Del Carmen S, Sayagués JM, Bengoechea O, Anduaga MF, Alcazar JA, Gervas R, García J, Orfao A, Bellvis LM, Sarasquete ME and Del Mar Abad M: Spatio-temporal tumour heterogeneity in metastatic CRC tumours: A mutational-based approach. Oncotarget. 9:34279–34288. 2018.PubMed/NCBI View Article : Google Scholar

53 

Blank A, Roberts DE II, Dawson H, Zlobec I and Lugli A: Tumour heterogeneity in primary colorectal cancer and corresponding metastases. Does the apple fall far from the tree? Front Med (Lausanne). 5(234)2018.PubMed/NCBI View Article : Google Scholar

54 

Eide PW, Moosavi SH, Eilertsen IA, Brunsell TH, Langerud J, Berg KCG, Røsok BI, Bjørnbeth BA, Nesbakken A, Lothe RA and Sveen A: Metastatic heterogeneity of the consensus molecular subtypes of colorectal cancer. NPJ Genom Med. 6(59)2021.PubMed/NCBI View Article : Google Scholar

55 

Hirata A, Hatano Y, Niwa M, Hara A and Tomita H: Heterogeneity of colon cancer stem cells. Adv Exp Med Biol. 1139:115–126. 2019.PubMed/NCBI View Article : Google Scholar

56 

Arakawa K, Hata K, Nozawa H, Kawai K, Tanaka T, Nishikawa T, Sasaki K, Shuno Y, Kaneko M, Hiyoshi M, et al: Molecular subtypes are frequently discordant between lesions in patients with synchronous colorectal cancer: Molecular analysis of 59 patients. Anticancer Res. 39:1425–1432. 2019.PubMed/NCBI View Article : Google Scholar

57 

Li ZN, Zhao L, Yu LF and Wei MJ: BRAF and KRAS mutations in metastatic colorectal cancer: Future perspectives for personalized therapy. Gastroenterol Rep (Oxf). 8:192–205. 2020.PubMed/NCBI View Article : Google Scholar

58 

Christensen TD, Palshof JA, Larsen FO, Poulsen TS, Høgdall E, Pfeiffer P, Jensen BV, Yilmaz MK and Nielsen D: Associations between primary tumour RAS, BRAF and PIK3CA mutation status and metastatic site in patients with chemo-resistant metastatic colorectal cancer. Acta Oncol. 57:1057–1062. 2018.PubMed/NCBI View Article : Google Scholar

59 

Fedyanin M, Stroganova A, Senderovich A, Dranko S, Tryakin A, Polyanskaya E, Popova A, Sekhina O, Rasulov A, Gordeev S, et al: Factors associated with discordance of KRAS, NRAS, BRAF, PIK3CA mutation status in the primary tumour and metastases in patients (pts) with colorectal cancer (CRC). Annals Oncol. 27 (Suppl 6)(VI174)2016.

60 

Watanabe T, Kobunai T, Yamamoto Y, Matsuda K, Ishihara S, Nozawa K, Iinuma H, Shibuya H and Eshima K: Heterogeneity of KRAS status may explain the subset of discordant KRAS status between primary and metastatic colorectal cancer. Dis Colon Rectum. 54:1170–1178. 2011.PubMed/NCBI View Article : Google Scholar

61 

Siyar Ekinci A, Demirci U, Cakmak Oksuzoglu B, Ozturk A, Esbah O, Ozatli T, Celik B, Budakoglu B, Turker I, Bal O and Turan N: KRAS discordance between primary and metastatic tumour in patients with metastatic colorectal carcinoma. J BUON. 20:128–135. 2015.

62 

Ardito F, Razionale F, Salvatore L, Cenci T, Vellone M, Basso M, Panettieri E, Calegari MA, Tortora G, Martini M and Giuliante F: Discordance of KRAS mutational status between primary tumours and liver metastases in colorectal cancer: Impact on long-term survival following radical resection. Cancers (Basel). 13(2148)2021.PubMed/NCBI View Article : Google Scholar

63 

Estrella JS, Tetzlaff MT, Bassett RL Jr, Patel KP, Williams MD, Curry JL, Rashid A, Hamilton SR and Broaddus RR: Assessment of BRAF V600E status in colorectal carcinoma: Tissue-specific discordances between immunohistochemistry and sequencing. Mol Cancer Ther. 14:2887–2895. 2015.PubMed/NCBI View Article : Google Scholar

64 

Mas L, Bachet JB, Taly V, Bouché O, Taieb J, Cohen R, Meurisse A, Normand C, Gornet JM, Artru P, et al: BRAF mutation status in circulating tumour DNA from patients with metastatic colorectal cancer: Extended mutation analysis from the AGEO RASANC study. Cancers (Basel). 11(998)2019.PubMed/NCBI View Article : Google Scholar

65 

Bai H, Wang R, Cheng W, Shen Y, Li H, Xia W, Ding Z and Zhang Y: Evaluation of concordance between deficient mismatch repair and microsatellite instability testing and their association with clinicopathological features in colorectal cancer. Cancer Manag Res. 12:2863–2873. 2020.PubMed/NCBI View Article : Google Scholar

66 

Haraldsdottir S, Roth R, Pearlman R, Hampel H, Arnold CA and Frankel WL: Mismatch repair deficiency concordance between primary colorectal cancer and corresponding metastasis. Fam Cancer. 15:253–260. 2016.PubMed/NCBI View Article : Google Scholar

67 

Vyas M, Firat C, Hechtman JF, Weiser MR, Yaeger R, Vanderbilt C, Benhamida JK, Keshinro A, Zhang L, Ntiamoah P, et al: Discordant DNA mismatch repair protein status between synchronous or metachronous gastrointestinal carcinomas: Frequency, patterns, and molecular etiologies. Fam Cancer. 20:201–213. 2021.PubMed/NCBI View Article : Google Scholar

68 

Yaeger R: Heterogeneity in microsatellite instability in metastatic colorectal cancer: Mechanisms and clinical implications. J Natl Compr Canc Netw. 17:1263–1264. 2019.PubMed/NCBI View Article : Google Scholar

69 

De Smedt L, Lemahieu J, Palmans S, Govaere O, Tousseyn T, Van Cutsem E, Prenen H, Tejpar S, Spaepen M, Matthijs G, et al: Microsatellite instable vs stable colon carcinomas: Analysis of tumour heterogeneity, inflammation and angiogenesis. Br J Cancer. 113:500–509. 2015.PubMed/NCBI View Article : Google Scholar

70 

Levin-Sparenberg E, Bylsma LC, Lowe K, Sangare L, Fryzek JP and Alexander DD: A systematic literature review and meta-analysis describing the prevalence of KRAS, NRAS, and BRAF Gene mutations in metastatic colorectal cancer. Gastroenterology Res. 13:184–198. 2020.PubMed/NCBI View Article : Google Scholar

71 

Hu Y, Tao SY, Deng JM, Hou ZK, Liang JQ, Huang QG, Li LH, Li HB, Chen YM, Yi H, et al: Prognostic value of NRAS gene for survival of colorectal cancer patients: A systematic review and meta-analysis. Asian Pac J Cancer Prev. 19:3001–3008. 2018.PubMed/NCBI View Article : Google Scholar

72 

Wang J, Shen J, Huang C, Cao M and Shen L: Clinicopathological significance of BRAFV600E mutation in colorectal cancer: An updated meta-analysis. J Cancer. 10:2332–2341. 2019.PubMed/NCBI View Article : Google Scholar

73 

Wensink E, Bond M, Kucukkose E, May A, Vink G, Koopman M, Kranenburg O and Roodhart J: A review of the sensitivity of metastatic colorectal cancer patients with deficient mismatch repair to standard-of-care chemotherapy and monoclonal antibodies, with recommendations for future research. Cancer Treat Rev. 95(102174)2021.PubMed/NCBI View Article : Google Scholar

74 

Wheeler JM, Bodmer WF and Mortensen NJ: DNA mismatch repair genes and colorectal cancer. Gut. 47:148–153. 2000.PubMed/NCBI View Article : Google Scholar

75 

Hou JT, Zhao LN, Zhang DJ, Lv DY, He WL, Chen B, Li HB, Li PR, Chen LZ and Chen XL: Prognostic value of mismatch repair genes for patients with colorectal cancer: Meta-analysis. Technol Cancer Res Treat. 17(1533033818808507)2018.PubMed/NCBI View Article : Google Scholar

76 

Kang S, Na Y, Joung SY, Lee SI, Oh SC and Min BW: The significance of microsatellite instability in colorectal cancer after controlling for clinicopathological factors. Medicine (Baltimore). 97(e0019)2018.PubMed/NCBI View Article : Google Scholar

77 

Nojadeh JN, Behrouz Sharif S and Sakhinia E: Microsatellite instability in colorectal cancer. EXCLI J. 17:159–168. 2018.PubMed/NCBI View Article : Google Scholar

78 

Anele CC, Adegbola SO, Askari A, Rajendran A, Clark SK, Latchford A and Faiz OD: Risk of metachronous colorectal cancer following colectomy in Lynch syndrome: A systematic review and meta-analysis. Colorectal Dis. 19:528–536. 2017.PubMed/NCBI View Article : Google Scholar

79 

Duraturo F, Liccardo R, De Rosa M and Izzo P: Genetics, diagnosis and treatment of Lynch syndrome: Old lessons and current challenges. Oncol Lett. 17:3048–3054. 2019.PubMed/NCBI View Article : Google Scholar

80 

Boland CR and Goel A: Microsatellite instability in colorectal cancer. Gastroenterology. 138:2073–2087.e3. 2010.PubMed/NCBI View Article : Google Scholar

81 

Morelli MP, Overman MJ, Dasari A, Kazmi SMA, Mazard T, Vilar E, Morris VK, Lee MS, Herron D, Eng C, et al: Characterizing the patterns of clonal selection in circulating tumour DNA from patients with colorectal cancer refractory to anti-EGFR treatment. Ann Oncol. 26:731–736. 2015.PubMed/NCBI View Article : Google Scholar

82 

Van Emburgh BO, Sartore-Bianchi A, Di Nicolantonio F, Siena S and Bardelli A: Acquired resistance to EGFR-targeted therapies in colorectal cancer. Mol Oncol. 8:1084–1094. 2014.PubMed/NCBI View Article : Google Scholar

83 

Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, Kamiyama M, Hruban RH, Eshleman JR, Nowak MA, et al: Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 467:1114–1117. 2010.PubMed/NCBI View Article : Google Scholar

84 

Ricci-Vitiani L, Lombardi DG, Pilozzi E, Biffoni M, Todaro M, Peschle C and De Maria R: Identification and expansion of human colon-cancer-initiating cells. Nature. 445:111–115. 2007.PubMed/NCBI View Article : Google Scholar

85 

Sottoriva A, Kang H, Ma Z, Graham TA, Salomon MP, Zhao J, Marjoram P, Siegmund K, Press MF, Shibata D and Curtis C: A Big Bang model of human colorectal tumour growth. Nat Genet. 47:209–216. 2015.PubMed/NCBI View Article : Google Scholar

86 

Fujiyoshi K, Yamamoto G, Takahashi A, Arai Y, Yamada M, Kakuta M, Yamaguchi K, Akagi Y, Nishimura Y, Sakamoto H and Akagi K: High concordance rate of KRAS/BRAF mutations and MSI-H between primary colorectal cancer and corresponding metastases. Oncol Rep. 37:785–792. 2017.PubMed/NCBI View Article : Google Scholar

87 

Bhullar DS, Barriuso J, Mullamitha S, Saunders MP, O'Dwyer ST and Aziz O: Biomarker concordance between primary colorectal cancer and its metastases. EBioMedicine. 40:363–374. 2019.PubMed/NCBI View Article : Google Scholar

88 

Ruiz-Bañobre J, Kandimalla R and Goel A: Predictive biomarkers in metastatic colorectal cancer: A systematic review. JCO Precis Oncol. 3(PO.18.00260)2019.PubMed/NCBI View Article : Google Scholar

89 

Zou Y, Hu X, Zheng S, Yang A, Li X, Tang H, Kong Y and Xie X: Discordance of immunotherapy response predictive biomarkers between primary lesions and paired metastases in tumours: A systematic review and meta-analysis. EBioMedicine. 63(103137)2021.PubMed/NCBI View Article : Google Scholar

90 

Zou SM, Li WH, Wang WM, Li WB, Shi SS, Ying JM and Lyu N: The gene mutational discrepancies between primary and paired metastatic colorectal carcinoma detected by next-generation sequencing. J Cancer Res Clin Oncol. 144:2149–2159. 2018.PubMed/NCBI View Article : Google Scholar

91 

Guyot D'Asnières De Salins A, Tachon G, Cohen R, Karayan-Tapon L, Junca A, Frouin E, Godet J, Evrard C, Randrian V, Duval A, et al: Discordance between immunochemistry of mismatch repair proteins and molecular testing of microsatellite instability in colorectal cancer. ESMO Open. 6(100120)2021.PubMed/NCBI View Article : Google Scholar

92 

Mao C, Wu XY, Yang ZY, Threapleton DE, Yuan JQ, Yu YY and Tang JL: Concordant analysis of KRAS, BRAF, PIK3CA mutations, and PTEN expression between primary colorectal cancer and matched metastases. Sci Rep. 5(8065)2015.PubMed/NCBI View Article : Google Scholar

93 

Kim KP, Kim JE, Hong YS, Ahn SM, Chun SM, Hong SM, Jang SJ, Yu CS, Kim JC and Kim TW: Paired primary and metastatic tumour analysis of somatic mutations in synchronous and metachronous colorectal cancer. Cancer Res Treat. 49:161–167. 2017.PubMed/NCBI View Article : Google Scholar

94 

Jesinghaus M, Wolf T, Pfarr N, Muckenhuber A, Ahadova A, Warth A, Goeppert B, Sers C, Kloor M, Endris V, et al: Distinctive spatiotemporal stability of somatic mutations in metastasized microsatellite-stable colorectal Cancer. Am J Surg Pathol. 39:1140–1147. 2015.PubMed/NCBI View Article : Google Scholar

95 

Lee CC, Soon YY, Lum JHY, Tan CL and Tey JCS: Frequency of discordance in programmed death-ligand 1 (PD-L1) expression between primary tumours and paired distant metastases in advanced cancers: A systematic review and meta-analysis. Acta Oncol. 59:696–704. 2020.PubMed/NCBI View Article : Google Scholar

96 

Gerlinger M, Rowan AJ, Horswell S, Math M, Larkin J, Endesfelder D, Gronroos E, Martinez P, Matthews N, Stewart A, et al: Intratumour heterogeneity and branched evolution revealed by multiregion sequencing. N Engl J Med. 366:883–892. 2012.PubMed/NCBI View Article : Google Scholar

97 

Molinari F, Martin V, Saletti P, De Dosso S, Spitale A, Camponovo A, Bordoni A, Crippa S, Mazzucchelli L and Frattini M: Differing deregulation of EGFR and downstream proteins in primary colorectal cancer and related metastatic sites may be clinically relevant. Br J Cancer. 100:1087–1094. 2009.PubMed/NCBI View Article : Google Scholar

98 

He Q, Xu Q, Wu W, Chen L, Sun W and Ying J: Comparison of KRAS and PIK3CA gene status between primary tumours and paired metastases in colorectal cancer. Onco Targets Ther. 9:2329–2335. 2016.PubMed/NCBI View Article : Google Scholar

99 

Niitsu H, Hinoi T, Shimomura M, Egi H, Hattori M, Ishizaki Y, Adachi T, Saito Y, Miguchi M, Sawada H, et al: Up-front systemic chemotherapy is a feasible option compared to primary tumour resection followed by chemotherapy for colorectal cancer with unresectable synchronous metastases. World J Surg Oncol. 13(162)2015.PubMed/NCBI View Article : Google Scholar

100 

Giacchetti S, Itzhaki M, Gruia G, Adam R, Zidani R, Kunstlinger F, Brienza S, Alafaci E, Bertheault-Cvitkovic F, Jasmin C, et al: Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol. 10:663–669. 1999.PubMed/NCBI View Article : Google Scholar

101 

Stillwell AP, Buettner PG and Ho YH: Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg. 34:797–807. 2010.PubMed/NCBI View Article : Google Scholar

102 

Wang G, Wang W, Jin H, Dong H, Chen W, Li X, Li G and Li L: The effect of primary tumour radiotherapy in patients with Unresectable stage IV rectal or Rectosigmoid cancer: A propensity score matching analysis for survival. Radiat Oncol. 15(126)2020.PubMed/NCBI View Article : Google Scholar

103 

Poultsides GA and Paty PB: Reassessing the need for primary tumour surgery in unresectable metastatic colorectal cancer: Overview and perspective. Ther Adv Med Oncol. 3:35–42. 2011.PubMed/NCBI View Article : Google Scholar

104 

Park JH, Kim TY, Lee KH, Han SW, Oh DY, Im SA, Kang GH, Chie EK, Ha SW, Jeong SY, et al: The beneficial effect of palliative resection in metastatic colorectal cancer. Br J Cancer. 108:1425–1431. 2013.PubMed/NCBI View Article : Google Scholar

105 

Simillis C, Kalakouti E, Afxentiou T, Kontovounisios C, Smith JJ, Cunningham D, Adamina M and Tekkis PP: Tumour resection in patients with incurable localized or metastatic colorectal cancer: A systematic review and meta-analysis. World J Surg. 43:1829–1840. 2019.

106 

Feo L, Polcino M and Nash GM: Resection of the primary tumour in stage IV colorectal cancer: When is it necessary? Surg Clin North Am. 97:657–669. 2017.PubMed/NCBI View Article : Google Scholar

107 

www.beaumont.ie/media/Testing_Services_Offered1.pdf.

108 

Radiology Assistant: RECIST 1.1-and more. Response Evaluation Criteria In Solid Tumors. https://radiologyassistant.nl/more/recist-1-1/recist-1-1. Accessed December 7, 2021.

109 

Cutsem EV, Cervantes A, Nordlinger B and Arnold D: ESMO Guidelines Working Group. Metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 25 (Suppl 3):iii1–iii9. 2014.PubMed/NCBI View Article : Google Scholar

110 

Chiorean EG, Nandakumar G, Fadelu T, Temin S, Alarcon-Rozas AE, Bejarano S, Croitoru AE, Grover S, Lohar PV, Odhiambo A, et al: Treatment of patients with late-stage colorectal cancer: ASCO Resource-stratified guideline. JCO Glob Oncol. 6:414–438. 2020.PubMed/NCBI View Article : Google Scholar

111 

Muratore A, Zorzi D, Bouzari H, Amisano M, Massucco P, Sperti E and Capussotti L: Asymptomatic colorectal cancer with Un-Resectable liver metastases: Immediate colorectal resection or up-front systemic chemotherapy? Ann Surg Oncol. 14:766–770. 2007.PubMed/NCBI View Article : Google Scholar

112 

Pędziwiatr M, Mizera M, Witowski J, Major P, Torbicz G, Gajewska N and Budzyński A: Primary tumour resection in stage IV unresectable colorectal cancer: What has changed? Med Oncol. 34(188)2017.PubMed/NCBI View Article : Google Scholar

113 

Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, Weiser M, Temple LK, Wong WD and Paty PB: Outcome of primary tumour in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol. 27:3379–3384. 2009.PubMed/NCBI View Article : Google Scholar

114 

Seo GJ, Park JW, Yoo SB, Kim SY, Choi HS, Chang HJ, Shin A, Jeong SY, Kim DY and Oh JH: Intestinal complications after palliative treatment for asymptomatic patients with unresectable stage IV colorectal cancer. J Surg Oncol. 102:94–99. 2010.PubMed/NCBI View Article : Google Scholar

115 

Rahbari NN, Lordick F, Fink C, Bork U, Stange A, Jäger D, Luntz SP, Englert S, Rossion I, Koch M, et al: Resection of the primary tumour versus no resection prior to systemic therapy in patients with colon cancer and synchronous unresectable metastases (UICC stage IV): SYNCHRONOUS-a randomised controlled multicentre trial (ISRCTN30964555). BMC Cancer. 12(142)2012.PubMed/NCBI View Article : Google Scholar

116 

Moritani K, Kanemitsu Y, Shida D, Shitara K, Mizusawa J, Katayama H, Hamaguchi T and Shimada Y: Colorectal Cancer Study Group (CCSG) of Japan Clinical Oncology Group (JCOG). A randomized controlled trial comparing primary tumour resection plus chemotherapy with chemotherapy alone in incurable stage IV colorectal cancer: JCOG1007 (iPACS study). Jpn J Clin Oncol. 50:89–93. 2020.PubMed/NCBI View Article : Google Scholar

117 

Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, Aranda Aguilar E, Bardelli A, Benson A, Bodoky G, et al: ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 27:1386–1422. 2016.PubMed/NCBI View Article : Google Scholar

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Copy and paste a formatted citation
Spandidos Publications style
Hamed RA, Marks S, Mcelligott H, Kalachand R, Ibrahim H, Atyani S, Korpanty G and Osman N: Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre). Mol Clin Oncol 16: 40, 2022.
APA
Hamed, R.A., Marks, S., Mcelligott, H., Kalachand, R., Ibrahim, H., Atyani, S. ... Osman, N. (2022). Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre). Molecular and Clinical Oncology, 16, 40. https://doi.org/10.3892/mco.2021.2472
MLA
Hamed, R. A., Marks, S., Mcelligott, H., Kalachand, R., Ibrahim, H., Atyani, S., Korpanty, G., Osman, N."Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre)". Molecular and Clinical Oncology 16.2 (2022): 40.
Chicago
Hamed, R. A., Marks, S., Mcelligott, H., Kalachand, R., Ibrahim, H., Atyani, S., Korpanty, G., Osman, N."Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre)". Molecular and Clinical Oncology 16, no. 2 (2022): 40. https://doi.org/10.3892/mco.2021.2472
Copy and paste a formatted citation
x
Spandidos Publications style
Hamed RA, Marks S, Mcelligott H, Kalachand R, Ibrahim H, Atyani S, Korpanty G and Osman N: Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre). Mol Clin Oncol 16: 40, 2022.
APA
Hamed, R.A., Marks, S., Mcelligott, H., Kalachand, R., Ibrahim, H., Atyani, S. ... Osman, N. (2022). Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre). Molecular and Clinical Oncology, 16, 40. https://doi.org/10.3892/mco.2021.2472
MLA
Hamed, R. A., Marks, S., Mcelligott, H., Kalachand, R., Ibrahim, H., Atyani, S., Korpanty, G., Osman, N."Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre)". Molecular and Clinical Oncology 16.2 (2022): 40.
Chicago
Hamed, R. A., Marks, S., Mcelligott, H., Kalachand, R., Ibrahim, H., Atyani, S., Korpanty, G., Osman, N."Inoperable <em>de novo</em> metastatic colorectal cancer with primary tumour <em>in situ</em>: Evaluating discordant responses to upfront systemic therapy of the primary tumours and metastatic sites and complications arising from primary tumours (experiences from an Irish Cancer Centre)". Molecular and Clinical Oncology 16, no. 2 (2022): 40. https://doi.org/10.3892/mco.2021.2472
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