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Maintenance Therapy in Colorectal Cancer

Panelists:Fadi Braiteh, MD, Comprehensive Cancer Centers of Nevada; Richard M. Goldberg, MD, Ohio State University Comprehensive Cancer Center; Howard S. Hochster, MD, Yale Cancer Center; John L. Marshall, MD, Georgetown University Hospital
Published: Friday, Sep 11, 2015

 
A longer duration of treatment can be utilized for patients with colorectal cancer who continued to respond following 3 months of treatment with chemotherapy and bevacizumab, as long as there is a decrease in carcinoembryonic antigen (CEA) levels and good performance status, says Howard S. Hochster, MD. While the best response to treatment is usually seen at 3 months, patients often continue to respond, notes Hochster. During the extended treatment period, scans should be repeated every 2 months.

After 6 months of treatment, Richard L. Goldberg, MD, transitions patients to maintenance therapy (often with fluoropyrimidine and bevacizumab), while continuing to monitor CEA levels. However, in regard to this approach, ASCO is proposing a bundle payment pathway based on outcome, which may impact treatment decisions regarding maintenance therapy with bevacizumab. This decision is based on meta-analyses that showed a minimal benefit with maintenance bevacizumab, suggesting that it is not a cost-effective treatment, suggests Goldberg.
 
The economic assessments are based on less than optimal metrics, states Hochster, noting that clinical trials may have design flaws that underestimate the true benefit of a regimen.
 
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A longer duration of treatment can be utilized for patients with colorectal cancer who continued to respond following 3 months of treatment with chemotherapy and bevacizumab, as long as there is a decrease in carcinoembryonic antigen (CEA) levels and good performance status, says Howard S. Hochster, MD. While the best response to treatment is usually seen at 3 months, patients often continue to respond, notes Hochster. During the extended treatment period, scans should be repeated every 2 months.

After 6 months of treatment, Richard L. Goldberg, MD, transitions patients to maintenance therapy (often with fluoropyrimidine and bevacizumab), while continuing to monitor CEA levels. However, in regard to this approach, ASCO is proposing a bundle payment pathway based on outcome, which may impact treatment decisions regarding maintenance therapy with bevacizumab. This decision is based on meta-analyses that showed a minimal benefit with maintenance bevacizumab, suggesting that it is not a cost-effective treatment, suggests Goldberg.
 
The economic assessments are based on less than optimal metrics, states Hochster, noting that clinical trials may have design flaws that underestimate the true benefit of a regimen.
 
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