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Second-Line Therapy for RAS Wild-Type mCRC

Insights From: Marwan G. Fakih, MD,City of Hope
Published: Thursday, Apr 23, 2015
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In terms of the continuum of care for patients with metastatic colorectal cancer (mCRC), the choice of first-line chemotherapy has a major impact on deciding what to use at progression. According to Marwan Fakih, MD, anti-EGFR therapy is being used in the frontline setting in patients with RAS wild-type tumors more frequently, leading to the question of optimal second-line treatment in this setting.

Second-line treatment selection is a complicated process, explains Fakih, since there are several options to consider both in the first- and second-line setting. Fakih prefers to administer an EGFR-targeted agent for a patient with RAS wild-type mCRC that is rapidly progressing, to downstage the tumor as quickly as possible. But for low-volume disease, there is still debate concerning whether an anti-EGFR or anti-angiogenic therapy results in better overall survival.

Each treatment is associated with unique side effects, which can be used to tailor therapy. Bevacizumab is occasionally administered in the frontline setting, with EGFR-targeted therapy saved for later to delay the onset of skin toxicity related to EGFR inhibition, notes Fakih.
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For High-Definition, Click
In terms of the continuum of care for patients with metastatic colorectal cancer (mCRC), the choice of first-line chemotherapy has a major impact on deciding what to use at progression. According to Marwan Fakih, MD, anti-EGFR therapy is being used in the frontline setting in patients with RAS wild-type tumors more frequently, leading to the question of optimal second-line treatment in this setting.

Second-line treatment selection is a complicated process, explains Fakih, since there are several options to consider both in the first- and second-line setting. Fakih prefers to administer an EGFR-targeted agent for a patient with RAS wild-type mCRC that is rapidly progressing, to downstage the tumor as quickly as possible. But for low-volume disease, there is still debate concerning whether an anti-EGFR or anti-angiogenic therapy results in better overall survival.

Each treatment is associated with unique side effects, which can be used to tailor therapy. Bevacizumab is occasionally administered in the frontline setting, with EGFR-targeted therapy saved for later to delay the onset of skin toxicity related to EGFR inhibition, notes Fakih.
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