Colorectal cancer (CRC) is the third most common cancer worldwide, with surgery being the primary treatment for localized disease. However, for patients with locally advanced or recurrent CRC, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has become a standard of care. HIPEC is a treatment approach that involves delivering a high concentration of chemotherapy directly into the peritoneal cavity (the area that surrounds the abdominal organs) during surgery. The chemotherapy is heated to a temperature of 41-43°C, which enhances its effectiveness by increasing the penetration of the drug into the tumor tissue and potentially killing more cancer cells.
While CRS with HIPEC is an effective treatment for advanced CRC, it is also associated with significant morbidity and mortality rates. Therefore, some patients may seek alternative treatments that are less invasive or have fewer side effects. In this answer, we will discuss some alternative treatments for CRC that have been investigated in scientific studies.
Systemic Chemotherapy: Systemic chemotherapy is the standard treatment for metastatic colorectal cancer. It involves the administration of chemotherapy drugs through the bloodstream to reach cancer cells throughout the body. While it is not as effective as HIPEC in treating peritoneal metastases, it can still be effective in controlling the progression of the disease in some patients. Several chemotherapy regimens have been approved for the treatment of metastatic CRC, including FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin), FOLFIRI (5-fluorouracil, leucovorin, and irinotecan), and FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin).
Targeted Therapy: Targeted therapy is a type of cancer treatment that targets specific molecules that are involved in the growth and spread of cancer cells. Two targeted therapies that are approved for the treatment of metastatic CRC are bevacizumab and cetuximab. Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), a protein that promotes the growth of new blood vessels in tumors. Cetuximab is a monoclonal antibody that targets the epidermal growth factor receptor (EGFR), a protein that is overexpressed in many types of cancer cells.
Immunotherapy: Immunotherapy is a type of cancer treatment that uses the patient’s own immune system to fight cancer. It works by stimulating the immune system to recognize and attack cancer cells. Two immunotherapy drugs that have been approved for the treatment of metastatic CRC are pembrolizumab and nivolumab. These drugs target the programmed death-1 (PD-1) protein, which is expressed on the surface of T cells and inhibits their ability to attack cancer cells.
Regional Chemotherapy: Regional chemotherapy involves delivering chemotherapy drugs directly to the tumor or the organ affected by cancer. This approach can be less invasive than CRS with HIPEC and can be used to treat both primary and metastatic CRC. Two regional chemotherapy approaches that have been investigated in clinical trials are hepatic arterial infusion (HAI) and transarterial chemoembolization (TACE). HAI involves delivering chemotherapy drugs directly into the hepatic artery (the blood vessel that supplies blood to the liver) using a catheter. TACE involves injecting chemotherapy drugs and embolic agents (substances that block the blood vessels that supply the tumor) into the blood vessels that supply the tumor.
Radiofrequency Ablation (RFA): RFA is a minimally invasive treatment that uses high-frequency electrical currents to heat and destroy cancer cells. It can be used to treat both primary and metastatic CRC. RFA is typically performed using a needle that is inserted into the tumor under image guidance. The needle is then used to deliver the electrical current to the tumor, which heats and destroys the cancer cells.
In conclusion, while CRS with HIPEC remains the standard of care for advanced CRC, there are several alternative treatments that have been investigated in clinical trials. These treatments include systemic chemotherapy, targeted therapy, immunotherapy, regional chemotherapy, and radiofrequency ablation. The choice of treatment will depend on several factors, including the stage and location of the cancer, the patient’s overall health, and their preferences. Patients should discuss their treatment options with their healthcare team to determine the best course of action.