Dr. Shields on the Standard of Care in Newly Diagnosed mCRC

Anthony Shields, MD, PhD, oncologist, Department of Oncology, Molecular Imaging and Diagnostics Program, Barbara Ann Karmanos Cancer Institute, discusses the standard of care in patients with newly diagnosed metastatic colorectal cancer (mCRC).

Several targeted therapies are under investigation, mainly in the second- and third-line setting, says Shields. Sequencing the number of available agents has become a challenge, especially for community oncologists, he adds. Moreover, it is unclear when to pull back on an agent. If a patient is started on a regimen like FOLFOXIRI and bevacizumab (Avastin), data suggest that patients are better served by pulling back on the drug after a few months and continuing on maintenance therapy. Determining when, and in whom this should be done, poses another challenge.

Therefore, patient personalization and preference should be used to determine the optimal approach. For example, a patient may express that they want to take a break from treatment after receiving a particularly challenging regimen. If their disease is under control and they have had a decent response, treatment cessation may be feasible. However, if the patient still has fairly active disease, maintenance might be the best option, concludes Shields.