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The treatment of patients with colorectal cancer (CRC) has evolved significantly over the course of 10 years, going from chemotherapy alone to chemotherapy regimens in combination with biologic agents. Results from the recent phase III 80405 study has further solidified this standard of care for patients with metastatic CRC, notes Tanios S. Bekaii-Saab, MD.
In the phase III CALGB/SWOG 80405 trial, frontline therapy with bevacizumab or cetuximab combined with FOLFOX or FOLFIRI was compared in patients with KRAS wild-type mCRC. The median overall survival was 29 months in the bevacizumab arm and 29.9 months in the cetuximab arm (HR = 0.925; P
= .34). The median PFS was 10.8 months with bevacizumab versus 10.4 months with cetuximab (HR = 1.04; P
The next step for CRC research will be the exploration of the molecular and biologic mechanisms behind the disease, states Al B. Benson III, MD. Additionally, advances are still required for the treatment of metastatic disease, since the only curative approach currently available remains surgery, Benson notes. The 80405 study did not change the standard of care, it affirmed it, notes Alan P. Venook, MD. However, despite the promising result in this study, it is clear that some patients did not respond. As a result, further research is needed to improve outcomes and potentially achieve cures.
The next generation of clinical trials in CRC will focus on molecular selection of patients and targeted therapies, believes Axel Grothey, MD. The next challenge will be to integrate targeted therapies into clinical trials based on upfront molecular assessment. In this regard, 80405 could serve as the last benchmark trial for the efficacy of established agents in CRC, notes Grothey.
At this point, the treatment of CRC is poised on the edge of an explosion of biologically derived therapies, believes Charles D. Blanke, MD. The next step will be to further personalize care for patients with this disease.