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John Marshall, MD, asks the participants how they would approach third-line treatment in patients with KRAS
wild-type metastatic colorectal cancer who have received FOLFOX/bevacizumab as first-line therapy and FOLFIRI/ziv-aflibercept as second-line therapy.
Anti-EGFR therapy in combination with irinotecan is recommended by Marwan Fakih, MD. Heinz-Josef Lenz, MD, would administered chemotherapy based on a number of factors, including the timing since the patient’s last chemotherapy, the presence or absence of symptomatic disease, and tumor burden.
Whether patients should continue bevacizumab as part of third-line therapy remains an open question, Alan Venook, MD, comments. Additionally, dual biologic therapy will be evaluated in future clinical trials, Venook notes.
Wrapping up the discussion, Marshall asks the panelists what dosing schedule they use with cetuximab, and whether they use premedication. Venook, Fakih, Lenz, and Johanna Bendell, MD, administer cetuximab every 2 weeks; Venook, Fakih, and Bendell use premedication at every visit, whereas Lenz uses premedication only once.