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Dr. John L. Marshall on Y-90 in Colorectal Cancer

John L. Marshall, MD
Published: Wednesday, Nov 23, 2016


John L. Marshall, MD, chief, Division of Hematology and Oncology, Medstar Georgetown University Hospital, and director, Otto J. Ruesch Center for the Cure of Gastrointestinal Cancers, discusses Y-90 in metastatic castration resistant colorectal cancer (mCRC).
 
There are new and exciting therapies for liver-dominant patients who can’t have surgery, says Marshall. There is evidence that liver-directed therapy, injected to treat and control liver metastases, may be effective, whether that is with traditional chemotherapy or Yttrium-90 (Y-90).
 
In the SIRFLOX study, patients were randomized to receive FOLFOX6 plus bevacizumab (Avastin) versus FOLFOX6 and bevacizumab plus Y-90 at the beginning of treatment. This type of regimen is typically used as a salvage refractory therapy, says Marshall.
 
The study showed that there was a 12-month liver progression-free survival (PFS) with FOLFOX6 plus bevacizumab versus a 20-month PFS with bevacizumab plus Y-90.
 
An overall survival analysis still needs to be done to verify these findings.

One challenge is that in this study, patients were included who had extrahepatic disease. This impacted overall PFS, causing no significant difference between the two arms, says Marshall.
 

John L. Marshall, MD, chief, Division of Hematology and Oncology, Medstar Georgetown University Hospital, and director, Otto J. Ruesch Center for the Cure of Gastrointestinal Cancers, discusses Y-90 in metastatic castration resistant colorectal cancer (mCRC).
 
There are new and exciting therapies for liver-dominant patients who can’t have surgery, says Marshall. There is evidence that liver-directed therapy, injected to treat and control liver metastases, may be effective, whether that is with traditional chemotherapy or Yttrium-90 (Y-90).
 
In the SIRFLOX study, patients were randomized to receive FOLFOX6 plus bevacizumab (Avastin) versus FOLFOX6 and bevacizumab plus Y-90 at the beginning of treatment. This type of regimen is typically used as a salvage refractory therapy, says Marshall.
 
The study showed that there was a 12-month liver progression-free survival (PFS) with FOLFOX6 plus bevacizumab versus a 20-month PFS with bevacizumab plus Y-90.
 
An overall survival analysis still needs to be done to verify these findings.

One challenge is that in this study, patients were included who had extrahepatic disease. This impacted overall PFS, causing no significant difference between the two arms, says Marshall.
 

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