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The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, October 22–24, 2009. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management colorectal cancer, such as the management of hepatic and pulmonary metastases, the role of monoclonal antibodies to the epidermal growth factor receptor, and the benefits and safety of chemotherapy in elderly patients. The management of gastrointestinal neuroendocrine tumours and gastric cancer are also discussed.
The Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, October 22–24, 2009. The report presented here is a consensus opinion produced by oncologists and allied health professionals invited from across Eastern Canada for the purpose of recommending management strategies for patients with colorectal cancer (crc) and selected gastrointestinal cancers.
The participants were oncology professionals from across Ontario, Quebec, and the Atlantic provinces invited to attend the consensus meeting.
The target audience for this report is primarily health professionals involved in the care of patients with crc and selected gastrointestinal cancers.
This report is intended to provide information about the standard of care to administrators responsible for program and funding decisions—key players in the implementation of best practice.
While not specifically targeted to patients, this report also provides information that may be useful to patients in guiding their decisions regarding care.
The recommendations provided here were based on presentation and discussion of best available evidence. Where applicable, references are cited.
These were the levels of evidence used in the presentations 1:
The consensus statements apply to broad populations of patients and may therefore not apply to the unique circumstances of an individual patient. Individual decisions for care are always made within a doctor–patient relationship.
Where possible, patients should be encouraged to participate in clinical trials.
Question: What are the principles involved in defining patients with metastatic crc for hepatic resection?
Question: Is there a role for liver biopsy in patients with suspected liver metastases from metastatic crc?
Question: What is the role of conversion strategies in the management of crc patients with unresectable liver metastases?
Question: What is the role of radiotherapy in the management of crc liver metastases?
Question: What is the role of pulmonary resection in patients with metastatic crc involving lungs?
Question: What is the role of cetuximab or panitumumab as monotherapy in the treatment of patients with chemo-refractory metastatic crc (mcrc)?
Question: What is the role of cetuximab and panitumumab in combination with chemotherapy in the treatment of patients with mcrc?
Question: What is the effect of increasing age on the benefit of adjuvant chemotherapy for crc?
Question: What is the effect of increasing age on the benefits and safety of palliative chemotherapy for mcrc?
Question: Should access to therapies for mcrc be limited by “lines of therapy” or an arbitrary number of cycles?
Question: What role do biomarkers for gastrointestinal neuroendocrine tumours (nets) play?
Question: What is optimal imaging for nets?
Question: What is the optimal pathology reporting for nets?
Question: What is the optimal medical therapy (“biotherapy”) for patients with well-differentiated metastatic midgut nets?
Question: What is the role of cytotoxic chemotherapy for nets?
Question: What is the optimal therapy for progressive pancreatic nets?
Question: Does chemotherapy provide a clinical benefit to patients with advanced gastric cancer?
Question: Is there a standard chemotherapy for initial use in advanced gastric cancer?
Question: Does trastuzumab offer clinical benefit to patients with advanced gastric cancer?
The authors acknowledge the sponsors who provided an unrestricted grant: Amgen, AstraZeneca, Bayer, Bristol–Myers Squibb, Hoffmann–La Roche, and Sanofi–Aventis. Sponsors were permitted to send observing representatives who did not participate in discussion or development of the consensus statements.