Dr. Mahipal on Maintenance Therapy in CRC

Amit Mahipal, MBBS, senior associate consultant, Division of Medical Oncology, Department of Oncology, associate professor of oncology, Mayo Clinic, discusses maintenance therapy in colorectal cancer (CRC).

In terms of maintenance therapy, there have been several trials looking at ways to improve the quality of life for patients, says Mahipal. For example, investigators have looked at maintaining a patient on initial therapy, de-escalating their chemotherapy, as well as giving a chemotherapy-free interval. Right now, the standard, based on several trials, is to consider single-agent fluoropyrimidine with a biologic agent, adds Mahipal.

Additionally, maintenance chemotherapy can be given without negatively impacting overall survival. The first progression is probably sooner with the chemotherapy-free interval, says Mahipal. However, when the therapy is reinstituted and is followed by a second progression, patients tend to have the same outcomes whether maintenance therapy was given or if they were continued on the same aggressive regimen.

This is especially true with a FOLFOX-based regimen, adds Mahipal, because patients develop neuropathy after approximately 8 cycles of treatment. As such, it becomes increasingly difficult to complete this regimen at the full dose, he concludes.