To what extent do you consider treatment effects on patients’ quality of life in advanced/metastatic colon cancer? Are the differences between chemotherapy regimens sufficient enough to inform your choice of combination chemotherapy and bevacizumab?
It's critically important to always consider quality of life issues anytime we're making a treatment decision in colorectal cancer. Certainly recognizing the differences and side effects of FOLFOX and FOLFIRI, you have to deal with the specific patient issues. I remember recently I was meeting a musician who was diagnosed with metastatic colorectal cancer for whom dexterity was an important issue, and so we talked about not using FOLFOX because he was concerned that any development of sensory neuropathy would affect his livelihood. In that circumstance, we would start with the FOLFIRI and he did extremely well, and that made sense.
Some patients may look at the FOLFIRI and say "well I have issues with regard to GI side effects that pre-date my diagnosis of colon cancer and I would prefer not to do FOLFIRI," though I want to emphasize that the rates of diarrhea with FOLFIRI are pretty modest. Some individuals may hear about the chance of hair loss and they may say "look, I don't want to do FOLFIRI. I'd rather do FOLFOX."
Unresectable Colon Cancer: Case 1
68-year-old man was diagnosed with advanced, unresectable colon cancer has just started treatment with FOLFIRI plus bevacizumab.