From the Guidelines
The treatment of metastatic colorectal cancer (mCRC) should prioritize targeted therapies based on molecular subtypes and primary tumor sidedness, in addition to conventional fluorouracil (FU)–based chemotherapy, as recommended by the 2023 ASCO guideline 1. When evaluating treatment options for mCRC, it is essential to consider the heterogeneity of the patient population, including different molecular subtypes.
- The 5-year relative overall survival (OS) for patients with mCRC is approximately 15% 1.
- Approximately 33% of patients with CRC will develop metastases either at presentation or follow-up 1.
- Treatment options for oligometastatic and liver-limited disease should be considered, as outlined in the 2023 ASCO guideline 1. The guideline provides a review of the evidence for areas of uncertainty in the treatment of mCRC, including indications for targeted therapy 1. Key considerations in the treatment of mCRC include:
- Conventional fluorouracil (FU)–based chemotherapy
- Targeted therapies for specific molecular subtypes
- Primary tumor sidedness
- Treatment options for oligometastatic and liver-limited disease By prioritizing targeted therapies and considering the individual characteristics of each patient, healthcare providers can optimize treatment outcomes and improve quality of life for patients with mCRC 1.
From the FDA Drug Label
2 K-Ras Wild-type, EGFR-expressing Colorectal Cancer (CRC) ERBITUX is indicated for the treatment of K-Ras wild-type, epidermal growth factor receptor (EGFR)-expressing, metastatic colorectal cancer (mCRC) as determined by an FDA-approved test [see Dosage and Administration (2. 2)]: in combination with FOLFIRI (irinotecan, fluorouracil, leucovorin) for first-line treatment, in combination with irinotecan in patients who are refractory to irinotecan-based chemotherapy, as a single-agent in patients who have failed oxaliplatin- and irinotecan-based chemotherapy or who are intolerant to irinotecan
3 BRAF V600E Mutation-Positive Metastatic Colorectal Cancer (CRC) ERBITUX is indicated, in combination with encorafenib, for the treatment of adult patients with metastatic colorectal cancer (CRC) with a BRAF V600E mutation, as detected by an FDA-approved test, after prior therapy [see Dosage and Administration (2.3)].
Cetuximab (ERBITUX) is indicated for the treatment of:
- K-Ras wild-type, EGFR-expressing metastatic colorectal cancer (mCRC) in combination with FOLFIRI, irinotecan, or as a single-agent.
- BRAF V600E mutation-positive metastatic colorectal cancer (CRC) in combination with encorafenib, after prior therapy. 2
From the Research
Colorectal Cancer (CRC) Treatment
- Oxaliplatin is a crucial therapeutic agent in CRC treatment, with a significant impact on disease management and outcome 3.
- The combination of oxaliplatin with other chemotherapeutic agents, such as fluoropyrimidines and irinotecan, is commonly used in the treatment of CRC 3.
- Studies have shown that oxaliplatin-based regimens can be effective in the treatment of relapsed colon cancer, with a median progression-free survival of 11.5 months and a median overall survival of 45.4 months 4.
Later-Line Treatment Options for mCRC
- Bevacizumab plus capecitabine has been shown to be a viable option for later-line treatment of patients with metastatic colorectal cancer (mCRC) refractory to irinotecan, oxaliplatin, and fluoropyrimidines, with a median progression-free survival of 4.6 months and a median overall survival of 9.7 months 5.
- Patients who had not received prior targeted agents showed better survival outcomes in the multivariable analysis of overall survival and progression-free survival 5.
Neoadjuvant Chemotherapy for Locally Advanced Colon Cancer
- A randomized, phase III trial (OPTICAL) investigated the use of neoadjuvant chemotherapy with oxaliplatin and fluoropyrimidine versus upfront surgery for locally advanced colon cancer, and found that neoadjuvant chemotherapy resulted in substantial pathologic downstaging and potentially improved overall survival 6.
- The study suggested that neoadjuvant chemotherapy with mFOLFOX6 or CAPOX may be a viable therapeutic option for locally advanced colon cancer, although it did not show a significant disease-free survival benefit 6.
Adjuvant Chemotherapy for Stage II and III Colon Cancer
- A systematic review found that patients with completely resected stage III colon cancer have an overall survival benefit from adjuvant chemotherapy, and that combination chemotherapy provides a larger benefit than monotherapy but with additional toxicity 7.
- For stage II colon cancer, a clear overall survival benefit has not been shown, although patients with high-risk stage II disease may benefit from adjuvant chemotherapy, and patients younger than 70 years of age may derive greater disease-free survival and overall survival benefit from adjuvant chemotherapy 7.