John L. Marshall, MD

John L. Marshall, MD, discusses the use of fruquintinib in the treatment of patients with metastatic colorectal cancer.

Panelists discuss how important clinical pearls include early genomic profiling, emphasizing lifestyle modifications like exercise programs that can reduce recurrence by 7%, and using olanzapine as the most effective antiemetic for delayed chemotherapy-related nausea.

Panelists discuss how immunotherapy generally provides better quality of life compared to traditional chemotherapy, particularly noting that microsatellite instability-high patients on immune checkpoint inhibitors report significantly better experiences than those on FOLFOX regimens.

Panelists discuss how they assess quality of life in clinical practice by asking simple questions like “What do you do for fun?” and “How was your week?” rather than relying solely on formal quality of life questionnaires.

Panelists discuss how they’re excited about future combination therapies, particularly TAS-102 with fruquintinib and novel immunotherapy approaches targeting patients with liver metastases who are typically checkpoint inhibitor refractory.

Panelists discuss how they approach rechallenge with chemotherapy, considering it primarily in patients who never truly progressed on oxaliplatin-based therapy or those who might benefit from EGFR antibody reintroduction after a drug holiday.

Panelists discuss how they manage fruquintinib dosing by starting at lower doses (3 to 4 mg) in patients with poor performance status or frailty, then titrating up as tolerated rather than starting at the full 5-mg dose.

Panelists discuss how they modify dosing schedules for TAS-102 (trifluridine/tipiracil), with some preferring every-other-week dosing instead of the standard 2-weeks-on schedule to reduce neutropenia and improve tolerability.

Panelists discuss how clinical trials remain the preferred option in third-line treatment, while acknowledging that regorafenib may benefit from dose reduction strategies and potential combination with immunotherapy in select patients.

Panelists discuss how 3 drugs (regorafenib, TAS-102, and fruquintinib) offer modest but meaningful survival benefits in treatment-refractory colorectal cancer, with TAS-102 plus bevacizumab being the preferred combination when tolerated.

Panelists discuss how circulating tumor DNA testing serves as the best prognostic technology available, particularly useful for identifying high-risk stage II patients who would benefit from adjuvant therapy, though surveillance strategies for positive results remain unclear.

Panelists discuss how doublet immunotherapy with ipilimumab and nivolumab provides superior outcomes compared to single-agent PD-1 therapy or chemotherapy in microsatellite instability-high colorectal cancer, supporting the “hit hard, hit early” approach.

Panelists discuss how the BREAKWATER trial demonstrates that upfront treatment with encorafenib plus cetuximab significantly improves outcomes in BRAF V600E-mutated colorectal cancer, turning a historically poor prognostic marker into a targetable opportunity.

Panelists discuss how dihydropyrimidine dehydrogenase testing remains controversial with institutions debating whether to implement universal pharmacogenomic testing given the challenges of standardization, genotype-phenotype correlation, and low incidence of severe deficiency.

John L. Marshall, MD; Marwan G. Fakih, MD; Arvind N. Dasari, MD, MS; and Katrina S. Pedersen, MD, discuss how precision medicine has transformed metastatic colorectal cancer treatment through comprehensive molecular testing, targeted therapies like BRAF/EGFR inhibition and immunotherapy combinations for microsatellite instability-high tumors, and personalized approaches to treatment sequencing and dosing modifications that balance efficacy with quality of life considerations.

John L. Marshall, MD, discuss updates in colorectal cancer management at the 2024 ASCO Annual Meeting.

The panelists provide their final thoughts, exploring the prospective treatment landscape for patients with CRC.

The expert panel continues the discussion with thoughts on gaps in our understanding and application of MRD testing for colorectal cancer and a look to the future, highlighting potential advancements.

Stacey Cohen, MD, discusses the rationale and study design of the phase 2/3 CIRCULATE-NORTH AMERICA study evaluating adjuvant chemotherapy selection based on MRD, and the panel discusses barriers to enrollment.

The panel continues its review of data presented on MRD testing in colorectal cancer from the INTERCEPT and COSMOS-CRC-01 studies.

The panel reviews recent data on MRD testing in colorectal cancer, highlighting the INTERCEPT and COSMOS-CRC-01 studies.

Benjamin A. Weinberg, MD, presents the case of a 35-year-old man with oligometastatic disease, and the panel provides insights on treatment decisions.

Pashtoon Murtaza Kasi, MD, MS, emphasizes key aspects of liquid biopsy and ctDNA testing in the MRD treatment landscape.

Pashtoon Murtaza Kasi, MD, MS, reviews data from the BESPOKE CRC study, highlighting overall results and patient-reported outcomes.

Focusing on the GALAXY arm in the CIRCULATE-Japan study, experts on colorectal cancer discuss how recent data are informing the evolving treatment landscape.

John L. Marshall, MD, presents the case of a 52-year-old woman with mid-rectal carcinoma, and the panel offers its initial impressions.

The panel discusses how MRD testing has evolved as a clinical tool in colorectal cancer, highlighting the phase 2/3 COBRA study and its implications.

Experts on colorectal cancer discuss practical considerations related to MRD testing, highlighting strategies to navigate potential challenges.

Pashtoon Murtaza Kasi, MD, MS, discusses MRD testing practices in the community oncology setting and provides recommendations on the integration of MRD testing into clinical practice.

Focusing on the adjuvant setting, the expert panel discusses the timing and frequency of MRD testing in patients with colorectal cancer.