Dr. Raghav on Treatment Options in Newly Diagnosed mCRC

Kanwal Raghav, MBBS, MD, associate professor, Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses treatment options in newly diagnosed, metastatic colorectal cancer (mCRC).

Typically, initial treatment for patients with mCRC consists of a chemotherapy backbone and a biological agent such as a VEGF inhibitor or an EGFR inhibitor.

EGFR inhibitors are reserved for patients with RAS wild-type tumors, says Raghav. Additionally, patients with right-sided, BRAF-mutant tumors, or HER2-amplified tumors do not derive significant benefit from anti-EGFR therapy.

Molecular testing should be performed prior to starting treatment to understand the potential risk-benefit ratio of anti-EGFR therapy, Raghav says. Moreover, these agents have some toxicity concerns that may impact a patient’s quality of life. As such, patients should be spared treatment if they are unlikely to benefit.

First-line chemotherapy with FOLFOX or FOLFIRI should be considered for patients with good performance status and aggressive disease, says Raghav.

Finally, clinical trials should be considered early in treatment as survival remains poor, concludes Raghav.