Panitumumab, Regorafenib, and Ziv-aflibercept in mCRC

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John Marshall, MD, begins by asking each panelist to describe the clinical situations in which they would use panitumumab as a treatment for patients with metastatic colorectal cancer (mCRC). Heinz-Josef Lenz, MD, Johanna Bendell, MD, and Marwan Fakih, MD, use panitumumab in the same patient population as cetuximab. Adverse events affecting the skin are more common with panitumumab, comments Fakih; he recommends topicals and antibiotics to prevent rash.

Next, Marshall asks the panelists to comment on the use of regorafenib in patients with KRAS-mutated mCRC. Fakih uses regorafenib in patients who are refractory to chemotherapy and are not candidates for clinical trials; additionally, he rechallenges patients with chemotherapy before initiating regorafenib. Alan Venook, MD, and Fakih take into account the presence of neuropathy before rechallenging a patient with oxaliplatin. When considering regorafenib, Fakih evaluates performance status and discusses the potential for toxicity with the patient.

Marshall wraps up the segment by asking the panelists to comment on the use of ziv-aflibercept in a hypothetical patient with the KRAS mutation who has a heavy tumor burden and experiences progression after 2 to 3 months of FOLFOX/bevacizumab therapy. Venook and Lenz agree that this would be a reasonable clinical scenario for the use of ziv-aflibercept.