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With the introduction of several new agents and drug combinations over the last several years, survival outcomes in patients with advanced CRC have shown vast improvement. The challenge now is to optimize medical therapy for individual patients. In this segment, Cathy Eng, MD discusses her approach to systemic therapy.
When deciding on first-line therapy, clinicians need to take into consideration whether the treatment objective is cure or palliation. For patients with unresectable tumors, Eng typically starts with a FOLFIRI/bevacizumab-based regimen as it is well-tolerated in these patients. However, for patients with resectable tumors, she usually starts with oxaliplatin-based therapy. Eng prefers anti-VEGF therapy in the first-line setting. Based on the EPOC trial data, she does not use anti-EGFR agents in patients with resectable tumors.
In the second-line setting, Eng continues anti-VEGF therapy in most patients. She is not against using anti-EGFR therapy; however, patients are often concerned about the toxicities associated with anti-EGFR therapy, thus Eng generally prefers anti-VEGF therapy. Eng encourages patients whose disease progresses rapidly with first-line therapy to consider enrolling in a clinical trial. However, for those not enrolled in a clinical trial, she has used aflibercept, which is approved in combination with irinotecan as a second-line regimen. In patients who are KRAS
-mutant with good performance status who have exhausted standard lines of therapy, she has used regorafenib.