Alan P. Venook, MD

Alan P. Venook, MD, The Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses adjuvant chemotherapy duration in colon cancer.

The challenge in the management of colon cancer is the inability to advance beyond the current standard of care, 5-fluorouracil (5-FU), leucovorin, and oxaliplatin (FOLFOX), which has shown curative benefits in the adjuvant setting. The problem with FOLFOX is that it causes peripheral neuropathy in almost all patients treated with the regimen, says Venook. The average onset of neuropathy with this regimen is between 7 and 8 doses, and the goal is to reach 12 cycles.

The goal of the IDEA trial, an international collaboration, was to answer the question of whether less chemotherapy would reduce the risk of neuropathy without sacrificing efficacy. The analysis involved more than 12,800 patients with low-risk advanced colon cancer, and results showed that most patients in this population would benefit from a 50% reduction in the oxaliplatin-containing chemotherapy that they typically receive after surgery, decreasing the likelihood of neuropathy and without significantly increasing their risk of recurrence.

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Alan P. Venook, MD, The Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses adjuvant chemotherapy duration in colon cancer.
 

Dr. Venook Discusses Adjuvant Chemotherapy Duration in CRC

Alan P. Venook, MD, The Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the role of chemotherapy in metastatic colorectal cancer (CRC).

Chemotherapy isn’t particularly critical in the treatment of metastatic CRC, Venook says. What is more important is the choice of biologic in combination with chemotherapy.

There is a suggestion that there is a benefit with cetuximab (Erbitux) in patients with all 

 wildtype CRC in combination with chemotherapy. In a US study though, data showed that bevacizumab (Avastin) and cetuximab are essentially the same in this combination, Venook adds.

Dr. Venook Discusses the Role of Chemotherapy in Metastatic CRC

Alan P. Venook, MD, The Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, provides advice to community oncologists who are treating patients with colorectal cancer (CRC).

As a community oncologist gets busier in his practice, it becomes even more important to not use a one-size-fits-all approach, Venook explains. It is critical to distinguish which patients are potentially curable and which are not. It is also beneficial to utilize biomarkers and to prepare for treatment.

 wild-type, a large majority of them have a poor prognosis. Therefore, it is likely more effective to enroll them on a clinical trial as opposed to standard therapy. Though there are plenty of subsets that have not yet been heavily researched, there are enough to work with to utilize a treatment-based approach.

Alan P. Venook, MD, The Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, provides advice to community oncologists who are treating patients with colorectal cancer.

Dr. Venook on Advice for Oncologists Treating Patients With CRC

Alan P. Venook, MD, The Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses important factors for oncologists to consider when treating patients with colorectal cancer (CRC).

The main issue, according to Venook, is whether the patient can potentially be cured, as some patients with metastatic CRC are curable. Patients with liver metastases have the best chance of being cured, he says.

Oncologists should certainly consider the overall goals of therapy, as well as how aggressively the patient can be treated, says Venook. Research thus far in this space is uncertain, in that there is no clear path for physicians to reference in treating these patients.

Venook compares the FIRE-3 and CALGB/SWOG 80405 studies to illustrate this point. In FIRE-3, the researchers looked at frontline cetuximab (Erbitux) plus chemotherapy versus bevacizumab (Avastin) plus chemotherapy, and showed a benefit with cetuximab. On the other hand, the 80405 study shows no difference between cetuximab and bevacizumab. Thus, Venook says future research should properly square away these inconsistencies and develop a clearer treatment path for these patients.

Alan P. Venook, MD, The Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses important factors for oncologists to consider when treating patients with colorectal cancer.

Author | Alan P. Venook, MD

Articles

Dr. Venook Discusses Adjuvant Chemotherapy Duration in CRC

Dr. Venook Discusses the Role of Chemotherapy in Metastatic CRC

Dr. Venook on Advice for Oncologists Treating Patients With CRC

Dr. Venook on Important Factors for Treating Patients With CRC