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.
Leonard B. Saltz, MD
As part of our coverage of the 2014 ASCO Annual Meeting, we discuss some of the colorectal cancer research that is expected to be presented at the meeting.
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.
In this interview we discuss the advances in treatment for colorectal cancer, as well as ongoing developments to find new and better therapies to treat this type of cancer.
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.
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 to
guide therapy. The clinician who fails to individualize therapy for
colorectal cancer is likely not taking full advantage of all therapeutic
options available. Reviewing key clinical evidence that can help inform
decision-making, this article addresses important questions in colorectal
cancer management, including: Should bevacizumab (Avastin) be a
component of most patients’ first-line treatment? Is there a role for
continuing bevacizumab in subsequent regimens? Is there a role for
cetuximab (Erbitux) in standard first-line chemotherapy? Are there
practices in colorectal cancer that have become widely accepted without
direct supportive data?