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Current Role of Chemotherapy in GI and Colorectal Cancer

John L. Marshall, MD
Published Online:6:34 PM, Wed August 15, 2018

John L. Marshall, MD, chief of the  Division of Hematology/Oncology at Medstar Georgetown University Hospital, Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer, discusses the use of chemotherapy in patients with colorectal (CRC) or other gastrointestinal (GI) cancers. He also highlights the importance of understanding each individual patient’s needs before making a treatment decision. 

According to Marshall, chemotherapy still plays an important and fundamental role for GI cancers across the board. The majority of patients will be put on chemotherapy despite recent discoveries with other treatment regimens, and most clinical trials even combine immunotherapy with chemotherapy. Marshall says we have seen a lot of positive results in trials like that already. 

In patients with CRC, a physician still must understand the type of tumor a patient has, the molecular profile at hand, and the choices available for this patient. If a really good response is needed, FOLFOXIRI and bevacizumab (Avastin) could be used, or EGFR therapy, if the patient has left-sided BRAFwild-type or RASwild-type CRC. These types of chemotherapy have demonstrated the best responses, Marshall says, but they can also be associated with significant toxicities. In some cases, stable disease may be enough, and another agent could be used instead. 

Decision making today is individualized. Marshall says it is like playing a game of chess, where moves are based upon the opponent you are facing, as opposed to checkers, where the same move is made over and over. Marshall encourages doctors play the best game of chess that they can.
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