Colorectal cancer is the third most common cancer in the United States and the third most common cause of cancer mortality. For those 50 years old and younger, the incidence of colorectal cancer is rapidly rising, and we don’t (yet) know why—although an abstract presented at the meeting showed that the microbiomes, which play a significant role in the development of cancer, are significantly different than those in older patients with colon cancer.
Like other cancers, discussions about colorectal cancer have centered on "what to do"—e.g., when to undergo surgery; and what kind of chemotherapy, targeted therapy, and/or immunotherapy to pursue.
The 2021 ASCO Annual Meeting discussions on colorectal cancer, however, focused more on "how to do it." As oncologists, we need to explore the harder-to-learn nuances on how to expertly and almost artfully deliver the right care to the right patient at the right time.
The key takeaways from ASCO were:
- The old paradigms of the treatment for metastatic colorectal cancer remain the standard of care. In a new study, a combination of the newer drug TAS-102 (lonsurf) + bevacizumab was inferior to FOLFIRI + bevacizumab.
- Patients with metastatic colon cancer require lifelong therapy, with maintenance therapy (treatment de-escalation) and treatment holidays:
- In select patients, drug holidays don’t negatively impact survival.
- Maintenance therapy inclusive of panitumumab (an EGFR antibody) in the RAS wild-type population is potentially better than maintenance therapy without panitumumab. However, in selecting maintenance therapy, we need to consider the side effects and toxicities.
- Liquidbiopsies (i.e., blood-based tests enabling us to see the tumor composition) can effectively guide the use of EGFR antibodies (panitumumab and cetuximab) in patients with RAS wild-type tumors.
- Treatments for locally advanced rectal cancer are evolving—with radiation, chemotherapy, surgery, and watchful waiting each having their own place. To choose the right option, we need to deeply understand each patient’s unique goals and needs.
This post was authored by Dr. Afsaneh Barzi.
Last updated July 14, 2021
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