Dr. Marshall on Considerations for Third-Line Therapeutic Options in CRC

John L. Marshall, MD, chief of the Division of Hematology/Oncology and a professor of Medicine and Oncology at Lombardi Comprehensive Cancer Center, as well as the director of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer, discusses factors to consider in the third-line treatment setting for patients with colorectal cancer (CRC). 

In the third-line setting for CRC, there are several available therapies, regorafenib (Stivarga), trifluridine/tipiracil (TAS-102; Lonsurf), and bevacizumab (Avastin), according to Marshall. A recent study showed that TAS-102 plus bevacizumab demonstrated a superior survival benefit compared with capecitabine plus bevacizumab in the frontline setting, which may indicate evolving ways of utilizing this regimen, Marshall continues. Additionally, more benefit is observed when treatments are tailored to the appropriate patients, Marshall says. 

Other considerations for treatment in later-line settings must take into account which drugs have and have not already been used, as well as the condition and mutational status of the patient, Marshall says. For example, for a patient with good performance status, low-volume disease, or asymptomatic disease, regorafenib is a good choice, Marshall explains. Similarly, if a patient has not received prior treatment with VEGF-targeted therapy and a response in needed, TAS-102 would be a feasible option. While there is no singular answer, it can be helpful to change mechanisms of action in this setting, although regorafenib is the most feasible option if stable disease is the goal, Marshall concludes.