Kanwal Raghav, MBBS, MD, discusses the role of molecular profiling in treatment selection for patients with metastatic colorectal cancer.
Kanwal Raghav, MBBS, MD, associate professor, Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the role of molecular profiling in treatment selection for patients with metastatic colorectal cancer (mCRC).
Patients with newly diagnosed mCRC should undergo up-front molecular profiling to identify potentially actionable alterations, says Raghav. For example, patients with microsatellite instability–high or mismatch repair deficient disease are likely to benefit from pembrolizumab (Keytruda).
Patients who harbor RAS mutations should receive bevacizumab (Avastin) in combination with chemotherapy, explains Raghav. Conversely, patients with RAS or BRAF wild-type mCRC and left-sided tumors could receive EGFR inhibitors in the frontline setting. Notably, EGFR inhibitors could be reserved for later-line therapy in patients with RAS or BRAF wild-type mCRC and right-sided tumors, Raghav says.
Additionally, patients should be tested for HER2 expression and amplification as HER2-directed therapies have demonstrated efficacy with successful outcomes in mCRC, Raghav says. Finally, patients with BRAF-mutant disease could be treated with standard of care encorafenib (Braftovi), binimetinib (Mektovi), and cetuximab (Erbitux) based on the phase 3 BEACON CRC trial. However, these patients could also be recommended for clinical trials, concludes Raghav.