Key Points in the Management of Metastatic Colorectal Cancer (mCRC)
- No single strategy is adequate for treating mCRC; care must be individualized based on molecular characteristics of the tumor as well as toxicity preferences and tolerances of the patient.
- A limited number of patients with oligometastatic disease are potentially curable. A realistic determination of curability vs incurability is necessary for proper treatment planning.
- FOLFOX and FOLFIRI are equally acceptable chemotherapy backbones for first-line therapy.
- Bevacizumab is typically added to first- and second-line regimens. I do not believe that data support use of single-agent bevacizumab. I do not use or recommend aflibercept.
- Although data suggest anti–epidermal growth factor receptor (EGFR) agents (cetuximab and panitumumab) are active with first-line regimens, I do not use or recommend these in first-line treatment, due to the impact of skin toxicity.
- Efficacy of anti-EGFR agents is limited to patients who develop grade 2 or 3 rash. Anti-EGFR agents should not be used in any line of therapy in patients with KRAS or NRAS mutations.