Dr Hitchcock on Potential Clinical Implications of the ERAsur Trial in Limited mCRC

Kathryn Hitchcock, MD, PhD, radiation oncologist, University of Florida Health, assistant professor, University of Florida, expands on potential clinical implications of the ongoing phase 3 ERAsur trial (NCT05673148) in metastatic colorectal cancer (mCRC).

The pragmatic, randomized trial is evaluating the use of total ablative therapy vs standard-of-care systemic therapy alone in patients with limited mCRC who are not candidates for resection or who have additional disease sites in the liver or lungs. Patients treated with total ablative therapy will receive any combination of stereotactic body radiation therapy with or without surgery and/or microwave ablation at all metastatic sites. Those given systemic therapy may receive physician’s choice of additional first-line systemic therapy, maintenance chemotherapy, or a pause in treatment.

The trial is currently open to enrollment at all National Clinical Trials Network sites in the United States, Hitchcock states. Fine points of the trial are still under consideration and open for potential adjustment, Hitchcock notes.

The goal of the trial is to inform the optimal use of local ablative therapy in this population, Hitchcock says. Previously reported retrospective data demonstrated an association between increased long-term overall survival (OS) and the application of aggressive local therapy to isolated metastases for patients with oligometastatic colorectal cancer. However, the ability of this approach to improve survival outcomes, cure rates, and longevity for patients with limited mCRC has been underresearched in a formal, randomized controlled setting, Hitchcock explains. In the event that findings are negative, the high cost and toxicities associated with total ablative therapy may render this approach ill-suited for patients with limited mCRC, she adds.

Additionally, data on circulating tumor DNA (ctDNA) levels will also be collected in the study, Hitchcock notes. These data may expand current understanding of the relationship between ctDNA and patient responses in CRC before, during, and after treatment, Hitchcock concludes.