Methods and Sequencing for First- and Next-Line Therapy of CRC

Chicago, Illinois—At the 2019 Great Debates & Updates in GI Malignancies meeting, Jeffrey A. Meyerhardt, MD, MPH, provided an update on the latest approaches for the first- and next-line treatment of patients with colorectal cancer (CRC).

Currently, patients with metastatic CRC have treatment options ranging from cytotoxic chemotherapy, to angiogenic inhibitors, and epidermal growth factor receptor (EGFR) inhibitors, even if their tumors overexpress HER2 or if they have disease that is microsatellite instability-high (MSI-H) or BRAF mutation–positive.

“For the majority of patients, the treatment goal is to extend life and maintain quality of life as long as possible,” explained Dr Meyerhardt.

Therapy options are influenced by factors including patient, molecular, and tumor characteristics, as well as patient preference.

“We have biomarkers which identify cancers that do not respond to certain therapies, and have specific therapy options…Next-generation sequencing should be performed for all patients with metastatic CRC. Test them as soon as possible so data are available for treatment decisions,” he added.

Importantly, he stressed that while patients benefit from access to all active agents, sequential therapy should be administered in the vein of a marathon, not a sprint.

In addition, Dr Meyerhardt shared considerations that should be made when selecting treatment options for patients with stage IV or recurrent CRC.

For patients with stage IV disease, the extent of metastatic disease, symptoms from the primary tumor, and isolated metastases amenable to localized therapy should be considered. Among those with recurrent CRC, considerations should be made for those with metastases limited to 1 organ (or a few metastases in >1 organ) and symptoms from metastases, and for timing of recurrence from primary treatment.

Bearing in mind that patients with CRC being considered for anti-EGFR therapy must undergo testing for the RAS mutation, angiogenic VEGFR and EGFR inhibitors can be used as first-, second-, and third-line therapies for metastatic disease.—Hina Porcelli