Treatment of pMMR/MSS Colon Cancer with Resectable Synchronous Liver or Lung Metastases
This protocol applies to patients with proficient mismatch repair (pMMR) / microsatellite stable (MSS) colon adenocarcinoma who present with synchronous metastases confined to the liver only and/or lung only, where the metastatic disease is considered resectable.
Defining Features of This Scenario
- pMMR / MSS tumour status
- Synchronous liver-only metastases
- Synchronous lung-only metastases
- Resectable metastatic disease
The combination of a confirmed pMMR/MSS molecular profile and resectable synchronous organ-limited metastases at diagnosis defines a distinct sub-population with curative-intent treatment options involving both surgery and systemic therapy.
Approach Overview
Management of this scenario is centred on curative-intent surgical resection — addressing both the primary colon tumour and the metastatic sites. Strategies may include simultaneous or staged operative approaches, and perioperative chemotherapy-based regimens can be incorporated either before or after surgery.
References
Proficient MMR (pMMR)/microsatellite stable (MSS)
Synchronous liver only and/or lung only metastases
Resectable
Synchronous or staged colectomy with liver or lung resection (preferred) and/or local therapy
Neoadjuvant therapy (for 2–3 mo) FOLFOX (preferred) or CAPEOX (preferred) or FOLFIRI (category 2B) or FOLFIRINOX (category 2B) followed by synchronous or staged colectomy and resection (preferred) and/or local therapy of metastatic disease
Colectomy, followed by chemotherapy (for 2–3 mo) FOLFOX (preferred) or CAPEOX (preferred) or FOLFIRI (category 2B) or FOLFIRINOX (category 2B) and staged resection (preferred) and/or local therapy of metastatic disease
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