Expert Insights Into Testing and Treatment for Metastatic Colorectal Cancer (mCRC)

Tanios Bekaii-Saab, MD, and colleagues address updates in metastatic colorectal cancer treatment, highlighting its prevalence in the U.S., the concerning rise in younger patients, and the ongoing uncertainty regarding the causes of this trend, with potential factors like environment and microbiome under investigation.

Daniel Ahn, DO, discusses the evolution of biomarker testing in metastatic colorectal cancer, highlighting the shift from understanding only the prognostic implications of genetic alterations to recognizing their predictive role in targeted therapies, and emphasizes the potential of circulating tumor DNA for rapid diagnosis and assessing treatment response.

Experts emphasize the importance of acquiring both tissue and circulating tumor DNA (ctDNA) for molecular testing in patients with metastatic colorectal cancer, address challenges such as lack of tissue and costs, and highlight the role of HER2 as a biomarker.

Daniel Walden, MD, presents the scenario of a 65-year-old man diagnosed with HER2+ metastatic colorectal cancer to the expert panel for discussion.

Christina Wu, MB, BCh, MD, shares the study design and efficacy data of the MOUNTAINEER-01 study, which explored combination tucatinib plus trastuzumab for the treatment of patients with HER2+ metastatic colorectal cancer.

Daniel Ahn, DO, and Tanios Bekaii-Saab, MD, detail the findings of the DESTINY-CRC02 trial, which examined the efficacy of trastuzumab deruxtecan at different dosing levels in breast cancer and gastric cancer patients.

In a detailed conversation, Tanios Bekaii-Saab, MD, Daniel Ahn, DO, and Christina Wu, MB, BCh, MD, discuss various scenarios for treating HER2+ metastatic colorectal cancer, focusing on patient profiling, testing methods, and different sequencing strategies including the use of trastuzumab.

Daniel Walden, MD, presents the scenario of a 66-year-old man diagnosed with BRAF V600E-mutant metastatic colorectal cancer to the expert panel for discussion.

Christina Wu, MB, BCh, MD, discusses BRAF V600E mutations in metastatic colorectal cancer, including the various detection methods, the different classes of BRAF mutations, and the evolution of targeting treatments.

Daniel Ahn, DO, describes the BEACON study, a randomized phase 3 trial in metastatic colorectal cancer that led to the FDA approval of a doublet regimen.

Christina Wu, MB, BCh, MD, shares data from the phase 3 BREAKWATER trial, which assesses first-line targeted treatment strategies for patients with BRAF V600E-mutant metastatic colorectal cancer.

Christina Wu, MB, BCh, MD, closes the program by expressing the necessity of enrolling patients with BRAF-mutant metastatic colorectal cancer in clinical trials, highlighting a second-line study led by the Southwest Oncology Group, new BRAF inhibitors, early phase studies at the Mayo Clinic, and an exciting study in the adjuvant setting.

Tanios S. Bekaii-Saab, MD, gave an overview of colorectal cancer along with current standard of care, and potential treatment options.

Personalized therapy tailored for mutation status is something to expect in the coming years for colorectal cancer treatment, notes Tanios S. Bekaii-Saab, MD.