ONCAlert | 2018 ASCO Annual Meeting
Colorectal Cancer Case Studies

Charles Fuchs, MD: First-Line Treatments in Unresectable Colon Cancer

Charles Fuchs, MD
Published Online:Apr 27, 2016
Case 1 examines a 68-year-old man was diagnosed with advanced, unresectable colon cancer has just started treatment with FOLFIRI plus bevacizumab.

Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1

Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 2
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 2


What are the first-line treatments for patients diagnosed with advanced, unresectable colon cancer? 

For a newly-diagnosed patient with metastatic colorectal caner, there are several options. Firstly, with regard to the chemotherapy backbone, one could either consider FOLFOX, namely an oxaliplatin-based regimen, or FOLFIRI, an irinotican-based regimen. What we know from the literature is that those two chemotherapy combinations have equivalent efficacy. They have some differences in toxicities, but both relatively well-tolerated and perfectly reasonable frontline regimens.

My own preference has historically been to start with FOLFOX, but I think FOLFIRI is an excellent regimen. With regard to the biologics that should be added to these regimens, and I think there's compelling evidence to add a biologic, bevacizumab is a very appropriate addition. That is the drugs that target the EGFR pathway have considering efficacy and there are several now approved. The combination of FOLFOX or FOLFIRI and bevacizumab is reasonable.

We also recognize that there is also an alternative approach, namely using the EGFR receptor antibodies – cetuximab or panitumamab – and we know from a recent CALGB study that the comparison of bevacizumab to cetuximab shows relative equivalence. So you could use an EGFR antibody or a VEGF antibody and get what is likely comparable benefit. The caveat is that you need to assess these patients for KRAS mutational status, because as we know, patients who have a tumor that is RAS mutated, those tumors do not respond to EGFR antibodies. So for a patient with a RAS wild type then I think you can give either bevacizumab or an EGFR antibody, but if it's RAS mutated in either KRAS or NRAS, then I would use bevacizumab.

Unresectable Colon Cancer: Case 1

68-year-old man was diagnosed with advanced, unresectable colon cancer has just started treatment with FOLFIRI plus bevacizumab.

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