Marwan G. Fakih, MD, professor, director, Gastrointestinal Medical Oncology, City of Hope, discusses recent advances in liver-directed therapies in colorectal cancer (CRC).

Fakih says there are different liver-directed therapies being evaluated in mCRC. One of the therapies that is receiving attention is radioembolization with yttrium 90. A lot of the data are with SIR-Spheres, a resin-based yttrium 90 product that is currently available and given through the hepatic artery.

Fakih says there are also liver-directed therapies with interarterial chemotherapy administration and there has also been some interest in drug-eluting beads with irinotecan in mCRC.

All of these modalities have either been investigated or are under investigation. Fakih says radioembolization is being tested in several clinical trials in either the first- or second-line setting. In the first-line setting, SIR-Spheres is being investigated in combination with FOLFOX in the FOXFIRE study. TheraSphere, another yttrium 90 product, is being investigated in the second-line treatment of mCRC, Fakih says.

Fakih says both products appear to be relatively safe, but complete data are not yet available. â€‹

Videos

Dr. Fakih on Advances in Liver-Directed Therapies in CRC

Marwan G. Fakih, MD, professor, director, Gastrointestinal Medical Oncology, City of Hope, discusses anti-angiogenesis versus anti-EGFR therapy in patients who have RAS wild-type colorectal cancer.

Fakih says it is important for researchers to figure out which therapy is more beneficial for patients who have RAS wild-type colorectal cancer in the first-line setting. There are hints that anti-EGFR therapy is effective in the first-line setting based on the FIRE-3 data, Fakih says, but it is important to see the results of C80405. Especially since the FIRE-3 data shows a lack of improvement in patient’s progression-free survival.

Dr. Fakih on Angiogenesis Versus EGFR Inhibitors in CRC

Marwan G. Fakih, MD, professor, director, Gastrointestinal Medical Oncology, City of Hope, discusses expanding 

 mutation testing for patients with colorectal cancer (CRC).

Recent data have shown that expanding traditional 

 mutations can better focus treatment with anti-EGFR therapy on a patient population that is most likely to derive benefit, Fakih says.

At the 2014 Gastrointestinal Cancers Symposium, there were several presentations supporting expanded testing with data from large analyses. One of these presentations, from study 20050181, reported that patients with traditionally wild-type non-exon 2 

 mutations (at exons 2, 3, and 4) did not benefit from anti-EGFR therapy with panitumumab.

This study, plus others, represents an overwhelming accumulation of data suggesting that it is necessary to move past traditional KRAS testing for the selection of anti-EGFR therapy in CRC, Fakih believes.

Marwan G. Fakih, MD, professor, director, Gastrointestinal Medical Oncology, City of Hope, discusses extended RAS mutations in colon cancer.

Marwan G. Fakih, MD

Articles

Dr. Fakih on Advances in Liver-Directed Therapies in CRC

Dr. Fakih on Angiogenesis Versus EGFR Inhibitors in CRC

Dr. Fakih on RAS Mutations in Colon Cancer