Dr. Marshall on Personalized Chemotherapy in CRC

John L. Marshall, MD, chief, Division of Hematology/Oncology, MedStar Georgetown University Hospital director, Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer, Georgetown-Lombardi Comprehensive Cancer Center, discusses personalized chemotherapy in the treatment of patients with colorectal cancer (CRC).

When a physician first diagnoses a patient with metastatic CRC, the questions are: “Can we cure this patient, and what is the role of chemotherapy?” In reality, Marshall says, surgery is not going to be an option, and as such, you are not going to cure most patients. Treating these patients is a long process, and some doctors tend to be heavy-handed when administering chemotherapy, Marshall notes.

While some high-risk patients require aggressive chemotherapy upfront, the vast majority of patients will actually benefit from low-intensity induction therapy followed by maintenance therapy. Marshall says the question should no longer be, “How much chemotherapy should we give?” but “How little chemotherapy can we give and still control the cancer?” Fundamentally, physicians are not trying to aggressively cure the disease, but control it. It is important to not be heavy-handed with chemotherapy and create significant toxicity.