Leonard B. Saltz, MD | Authors

Management of Metastatic Colorectal Cancer

October 15, 2014

The management of colorectal cancer is a complex endeavor that requires treatment individualization founded on molecular characterization of the tumor, an in-depth understanding of the patient, and an appreciation of the interaction between the two.

Colorectal Cancer Patients With Oligometastatic Liver Disease: What Is the Optimal Approach?

November 15, 2013

In a good percentage of patients who have oligometastatic disease confined to a single organ-usually the liver-complete metastasectomy can result in cure. However, once the decision to pursue surgery is made, there remain a number of issues that must be addressed in order to ensure the best possible outcome.

Treating Metastatic Colorectal Cancer While Questions Remain Unanswered

April 30, 2007

Over the past decade, new cytotoxic and biologic therapies beyond the old standard-of-care, biomodulated fluorouracil (5-FU), have become available for the treatment of metastatic colorectal cancer (mCRC). The introductions of irinotecan (Camptosar), oxaliplatin (Eloxatin), and bevacizumab (Avastin) have prolonged survival, but the optimal use of these new therapies remains to be determined. Issues remain regarding management of toxicities, treatment of elderly patients or those with poor performance status, and the duration of treatment with front-line therapy. This article reviews recent and ongoing studies of newer therapies in an effort to determine the best use of these drugs in the treatment of mCRC. Current data support the front-line use of bevacizumab added to either 5-FU/leucovorin alone or 5-FU/leucovorin in combination with oxaliplatin (FOLFOX/bevacizumab) or irinotecan (FOLFIRI/bevacizumab). If oxaliplatin is used in first-line therapy, oxaliplatin should be discontinued before the development of severe neurotoxicity and be reintroduced or replaced with irinotecan on disease progression. Definitive conclusions on the sequence and duration of front-line therapy and the most effective strategy to ameliorate toxicity await results of ongoing prospective clinical trials.

Commentary (Saltz)-Cetuximab-Associated Infusion Reactions: Pathology and Management

October 01, 2006

Cetuximab (Erbitux), a chimeric antiepidermal growth factor receptor monoclonal antibody currently used to treat metastatic colorectal cancer, is in clinical development for several other solid tumors. Although cutaneous manifestations are the most common toxicities associated with cetuximab, they are rarely life-threatening. Cetuximab-related infusion reactions are less common, but they may become severe and cause fatal outcomes if not managed appropriately. Little about the specific etiology of these events is known; however, an overview of infusion reactions observed with other compounds may shed some light and help characterize cetuximab-related reactions. For physicians administering cetuximab, familiarity with acute reaction treatment protocols and preparedness to identify and manage symptoms promptly and effectively are most important to minimize potential risks.

Metastatic Colorectal Cancer: Is There One Standard Approach?

August 01, 2005

Despite enormous advances in the treatment of colorectal cancer,there is no single standard treatment approach for all patients. However,there are general principles of management that can be used toguide therapy. The clinician who fails to individualize therapy forcolorectal cancer is likely not taking full advantage of all therapeuticoptions available. Reviewing key clinical evidence that can help informdecision-making, this article addresses important questions in colorectalcancer management, including: Should bevacizumab (Avastin) be acomponent of most patients’ first-line treatment? Is there a role forcontinuing bevacizumab in subsequent regimens? Is there a role forcetuximab (Erbitux) in standard first-line chemotherapy? Are therepractices in colorectal cancer that have become widely accepted withoutdirect supportive data?

Monoclonal Antibodies: The Foundation of Therapy for Colorectal Cancer in the 21st Century?

May 01, 2004

Drs. Hoff, Ellis, and Abbruzzesehave provided a thoroughand useful overview of thecurrent status of the two new monoclonalantibodies, cetuximab (Erbitux)and bevacizumab (Avastin), that haverecently become available for the treatmentof colorectal cancer.

The Role of Irinotecan and Oxaliplatin in the Treatment of Advanced Colorectal Cancer

April 01, 2001

Since its development in 1957, fluorouracil (5-FU) has been the central component in the treatment of colorectal cancer. Over the past several decades, innumerable permutations of fluorouracil biomodulation have been studied. Indeed, rarely has a drug been so well understood in terms of its mechanisms and metabolism, and rarely has such an understanding been so extensively exploited in clinical strategies. But despite these efforts, overall progress in the management of advanced colorectal cancer has been modest.

Perspectives on the Use of Fluorinated Pyrimidines

January 02, 2001

The fluorinated pyrimidines, in particular 5-fluorouracil (5-FU), are among the oldest cytotoxic agents still in broad use today. To some degree, this continued use of 5-FU is a bit of an embarrassment to those of us who spend considerable amounts of