Dr. Mizrahi on the Importance of Personalized Care in mCRC

Jonathan Mizrahi, MD
Published: Tuesday, Apr 23, 2019



Jonathan Mizrahi, MD, a hematology/oncology fellow at The University of Texas MD Anderson Cancer Center, discusses the importance of personalized care in patients with metastatic colorectal cancer (mCRC).

There is a limited number of cytotoxic chemotherapies that are efficacious for every patient with mCRC. 5-fluorouracil–based regimens with oxaliplatin and irinotecan are effective. Regorafenib (Stivarga) and TAS-102 (trifluridine/tipiracil; Lonsurf) have also shown promise in the refractory setting. Beyond that, personalized therapy is key, Mizrahi says.

Adding biologic agents like anti–EGFR therapy with cetuximab (Erbitux) is a prime example of individualized care. A number of patient factors like tumor sidedness, RAS status, microsatellite instability–high and mismatch repair deficiency can help practitioners make effective treatment decisions.

Rarer genetic alterations like BRAF also have to be taken into consideration. Once a patient’s mutational status is determined, the optimal combination regimen can be chosen. HER2-targeted therapy is also emerging for the 3% to 4% of patients who have HER2 amplification in their tumors. A greater adoption of molecular profiling will help researchers develop more therapies, Mizrahi concludes.
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Jonathan Mizrahi, MD, a hematology/oncology fellow at The University of Texas MD Anderson Cancer Center, discusses the importance of personalized care in patients with metastatic colorectal cancer (mCRC).

There is a limited number of cytotoxic chemotherapies that are efficacious for every patient with mCRC. 5-fluorouracil–based regimens with oxaliplatin and irinotecan are effective. Regorafenib (Stivarga) and TAS-102 (trifluridine/tipiracil; Lonsurf) have also shown promise in the refractory setting. Beyond that, personalized therapy is key, Mizrahi says.

Adding biologic agents like anti–EGFR therapy with cetuximab (Erbitux) is a prime example of individualized care. A number of patient factors like tumor sidedness, RAS status, microsatellite instability–high and mismatch repair deficiency can help practitioners make effective treatment decisions.

Rarer genetic alterations like BRAF also have to be taken into consideration. Once a patient’s mutational status is determined, the optimal combination regimen can be chosen. HER2-targeted therapy is also emerging for the 3% to 4% of patients who have HER2 amplification in their tumors. A greater adoption of molecular profiling will help researchers develop more therapies, Mizrahi concludes.



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