Finally, could you briefly discuss some of the cost issues associated with adding biologics to CT? How does the cost of bevacizumab compare with that of cetuximab? Given the outcome of the CALGB/SWOG 80405 study, what do you think is a cost-effective approach to using these agents?
There was a cost-effective analysis looking at CALGB 80405 which did the comparison of chemotherapy with bevacizumab, as opposed to chemotherapy plus cetuximab. That result suggested that perhaps bevacizumab was more cost effective than cetuximab. At the moment I think we as practicing oncologists are not bound to make our treatment decisions exclusively on cost. What I'm pleased to say is that we can often make those decisions based on what is really the optimal care for that specific patient, recognizing that we have to be mindful of cost considerations and ultimately I suspect our treatment paradigms will start to take that into account.
Unresectable Colon Cancer: Case 2
52-year-old woman newly diagnosed with metastatic CRC and is genotyped as part of her initial work up.