2021 CSCO guidelines update, one article to master the update points of gastrointestinal and biliary tumors

Palliative care second-line and third-line programs: separate MSI-H/dMMR patients, and PD-1 inhibitors (not limited to specific types) as level II recommendations (2A evidence);

The third-line palliative care regimen: new level III recommendation of trifluridine tepipyrimidine (TAS-102) + bevacizumab (class 2B evidence) and cetuximab + irinotecan (previously received cetuximab) Level III recommendation (3 types of evidence) for cilimab treatment)
.

3.
For the treatment of initial unresectable metastatic colon cancer, a new note: "When the metastasis is unresectable, there is still no consensus on whether the asymptomatic primary tumor needs to be resected and the best resection
.
Therefore, it needs to be in a multidisciplinary diagnosis and treatment model ( Individualized decision-making for each case under the framework of MDT) requires careful evaluation of tumor progression rate, estimated survival time, primary tumor location and size, perimeter of the intestinal cavity/intestinal stenosis, willingness and feasibility to accept the whole body quality Multiple factors such as sex are combined to determine whether to remove the primary tumor
.
"

4.
For patients with difficulty in retaining the sphincter, a new program of "intensified concurrent radiotherapy and chemotherapy (capecitabine combined with irinotecan) (re-evaluation) + radical resection of rectal cancer + adjuvant chemotherapy" (level I recommendation) ) (Class 1B evidence)
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Biliary Tract Tumors

Intrahepatic cholangiocarcinoma is now considered to be an anatomically defined disease entity with two different main subtypes: bold cast type, which is similar to extrahepatic cholangiocarcinoma; small cholangiocarcinoma, which has similar etiology and hepatocellular carcinoma.
Pathogenesis and imaging features
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The CSCO guidelines for diagnosis and treatment of malignant tumors of the biliary tract in 2021 mainly focus on radiotherapy and systemic treatment
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Radiotherapy update point

1.
Postoperative adjuvant radiotherapy is finally approved

For intrahepatic and extrahepatic bile duct malignant tumors with positive margins after surgery (R2 resection), postoperative adjuvant radiotherapy is recommended
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(Recommended by Level I Experts, Type 2A Evidence)

For intrahepatic and extrahepatic bile duct malignant tumors with N+ (lymph node positive) after R0, postoperative adjuvant radiotherapy is recommended
.
(Recommended by Level II Experts, Type 2A Evidence)

2.
Stereotactic body radiotherapy (SBRT) emerges in palliative radiotherapy

For inoperable but more limited intrahepatic cholangiocarcinoma, SBRT can be considered
.
(Recommended by Level II Experts, Type 2A Evidence)

System treatment update point

1.
Late second-line treatment adds another treatment option

The second-line treatment of advanced cholangiocarcinoma increases BRAF V600E mutant tumors, recommend dabrafenib + trametinib
.
(Recommended by Level II Experts, Type 2A Evidence)

2.
The first successful targeted therapy drug among biliary tumors

Ivosidenib (AG-120) is recommended for treated patients with intrahepatic cholangiocarcinoma who carry an isocitrate dehydrogenase (IDH1) mutation inhibitor
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(Recommended by Level III experts, Type 1A evidence)

3.
New dawn of targeted therapy for biliary malignant tumors

Fibroblast growth factor receptor 2 (FGFR2) gene fusion/rearrangement is recommended for TBC patients treated with pemigatinib or Infigratinib (BGJ389)
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(Recommended by Level III experts, Type 2A evidence)

4.
The effectiveness of targeted combined immunization research remains to be further explored

Lenvatinib + Pembrolizumab is used in the second-line treatment of cholangiocarcinoma
.
(Recommended by Level III experts, Type 2B evidence)

5.
New options for first-line treatment

GEMOX+lenvatinib+teriprolizumab is the first-line treatment of advanced biliary malignant tumors
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(Recommended by Level III experts, Type 2B evidence)

The above are the updated points of gastric cancer , colorectal cancer, and biliary tract tumors.
With the deepening of understanding of digestive system tumors, their treatment methods have become more diverse and perfect
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Under the precision treatment concept, cancer patients have more and better drugs to choose from, including a series of drug combinations such as targeting, immunity, and anti-angiogenesis.
New drugs and new research may bring more benefits to patients.
Exciting good news
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 Reference source:

"2021 CSCO Guidelines for Diagnosis and Treatment of Gastric Cancer"

"2021 CSCO Colorectal Cancer Diagnosis and Treatment Guidelines"

"2021 CSCO Guidelines for Diagnosis and Treatment of Biliary Tract Tumors"