Dr. Marshall on Challenges With Sequencing in CRC

John L. Marshall, MD, chief, Division of Hematology/Oncology, Medstar Georgetown University Hospital, professor of medicine and oncology, and director, Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer, Georgetown-Lombardi Comprehensive Cancer Center, discusses ​sequencing challenges in colorectal cancer (CRC).

Patients with CRC tend to receive multiple lines of therapy, says Marshall. Moreover, with the host of treatment options that are available, utilizing strict sequencing strategies in the frontline and relapsed/refractory settings may not be optimal for patients. 

For example, more aggressive therapies, such as FOLFIRINOX and bevacizumab (Avastin), are being utilized in the frontline setting for the majority of patients with CRC, Marshall says.

Then, patients may receive maintenance therapy, surgical resection, or radiation therapy, adds Marshall. 

Other therapies such as regorafenib (Stivarga) and TAS-102 (trifluridine/tipiracil; Lonsurf) are valuable drugs that can elicit 6 to 9 months of stable disease, Marshall says. 

However, ​timing with these agents is critical. Waiting too long to administer them could render patients ineligible to receive potentially valuable therapies, Marshall concludes.