I am pleased to work with the editor-in-chief of JNCCN, Hal Burstein, MD, PhD, in organizing this issue of the journal dedicated to colon and rectum cancer management, and I appreciate the opportunity to note some of the updates to the field in the past year.
In 2009, the NCCN Clinical Practice Guidelines in Oncology were expanded to include a survivorship component. Long-term follow-up care of colorectal cancer survivors should include management of late complications and encouraging patients to modify their lifestyle through improved exercise and diet.
Another major change in the guidelines represented the determination of tumor KRAS gene status before starting treatment with an epidermal growth factor receptor (EGFR) inhibitor, such as cetuximab or panitumumab. Data included in the guidelines show that patients whose tumor expresses KRAS mutation have little or no likelihood of responding to the EGFR inhibitors.
The edition of the guidelines published in this issue also emphasizes the use of systemic combination chemotherapy such as FOLFOX or FOLFIRI with or without bevacizumab in the attempt to reduce the size of colorectal metastasis as well as the primary tumor and to allow patients with initially unresectable disease to be candidates for resection.
These changes in the guidelines are reflected and expanded in the authored manuscripts. For example, Denlinger and Barsevick review the literature on colorectal cancer survivorship. They note clear evidence that quality of life is diminished when treatment-related symptoms, such as fatigue, distress, and sleep difficulties) plague colorectal cancer survivors. The long-term effects of treatment,...
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Paul F. Engstrom, MD, is the Chair of the NCCN Colon/Rectal/Anal Cancers Panel. He is currently Senior Vice President for Extramural Research Programs and Chief Network Officer, Fox Chase Partners, Fox Chase Cancer Center, Philadelphia, PA. He is also Professor of Medicine at Temple University School of Medicine.
Dr. Engstrom is the past Chairman of the G.I. Committee of the Eastern Cooperative Oncology Group, Chairman of the Board of Scientific Counselors, DCPC, NCI, and Chairman of the Scientific Advisory Board of the Armed Forces Institute of Pathology. He is presently a member of the Prevention Task Force and the Cancer Education Committee of the American Society of Clinical Oncology (ASCO). Dr. Engstrom is also a fellow of the American College of Physicians.
Dr. Engstrom received his medical degree from the University of Minnesota, Minneapolis. His postgraduate training includes and internship, residency, and medical oncology fellowship at the University of Minnesota Hospitals. He is board certified in internal medicine and holds subspecialty certification in medical oncology.