Ideas in this flowchart

• Treatment strategies for metastatic colorectal cancer
• The cancer has spread beyond the reach of surgery and standard chemotherapy.
• Immunotherapy is increasingly used.
• Combination targeted therapies are increasingly used.
• Localized interventional techniques address the spread disease.
• HIPEC
• PIPAC
• TACE
• The relevant patients are those whose cancer has stopped responding to first-line treatment.
• These interventions are not merely experimental footnotes.
• They are among the interventions most likely to change what the disease can still do.