Integrating Academic and Community Practices in the Management of Colorectal Cancer: The City of Hope Model

• Main Authors: Misagh Karimi, Chongkai Wang, Bahareh Bahadini, George Hajjar, Marwan Fakih
• Format: Article
• Language: English
• Published: MDPI AG 2020-06-01
• Series: Journal of Clinical Medicine
• Subjects: colorectal cancer; precisian medicine; academic and community oncology
• Online Access: https://www.mdpi.com/2077-0383/9/6/1687

Colorectal cancer (CRC) management continues to evolve. In metastatic CRC, several clinical and molecular biomarkers are now recommended to guide treatment decisions. Primary tumor location (right versus left) has been shown to predict benefit from anti-epidermal growth factor receptors (EGFRs) in rat sarcoma viral oncogene homologue (<i>RAS</i>) and v-raf murine sarcoma viral oncogene homolog B1 (<i>BRAF</i>) wild-type patients. Anti-EGFR therapy has not resulted in any benefit in <i>RAS</i>-mutated tumors, irrespective of the primary tumor location. <i>BRAF-V600E</i> mutations have been associated with poor prognosis and treatment resistance but may benefit from a combination of anti-EGFR therapy and BRAF inhibitors. Human epidermal growth factor receptor 2 (<i>HER-2</i>) amplification was recently shown to predict relative resistance to anti-EGFR therapy but a response to dual HER-2 targeting within the <i>RAS</i> wild-type population. Finally, the mismatch repair (MMR)-deficient subgroup benefits significantly from immunotherapeutic strategies. In addition to the increasingly complex biomarker landscape in CRC, metastatic CRC remains one of the few malignancies that benefits from metastasectomies, ablative therapies, and regional hepatic treatments. This treatment complexity requires a multi-disciplinary approach to treatment and close collaborations between various stakeholders in large cancer center networks. Here, we describe the City of Hope experience and strategy to enhance colorectal cancer care across its network.