Second Line and Later Therapies - Metastatic Colorectal Cancer

Dr. Ben Weinberg discusses second and later line treatment for Metastatic Colorectal Cancer. Common treatment for 1st and 2nd line is FOLFOX -- FOLFIRI, but with a deeper understanding of where the tumor or a patient’s genetic markers may indicate the need for other treatments (e.g. bevacizumab). For 3rd line treatments, trifluridine/tipiracil and Regorafenib are sometimes used. More videos like this: https://ruesch.georgetown.edu/rueschr... Transcript: For patients with metastatic colorectal cancer with disease growing on one line of chemotherapy, there are multiple treatment options that are still available. One is switching to another chemotherapy line, instead of FOLFOX or CAPOX, switching to a irinotecan-based therapy with FOLFIRI or CAPIRI continuing either pump Fluorouracil or a pill Capecitabine. This is often given in combination with a biologic, such as Avastin Bevacizumab, or it can be switched to a similar type of drug. And if your tumor happens to not have a RAS mutation or BRAF mutation, you may be eligible for another drug that targets the EGFR pathway, either Cetuximab Erbitux or Panitumumab Vectibix, especially if you have a left-sided primary tumor. Rarely patients have mutations in a gene called BRAF, patients can be then eligible for BRAF-directed therapy. Finally, a small sliver of patients have a microsatellite high tumor and can respond to immunotherapy. In the third line setting, the drugs trifluridine tipiracil, or Lonsurf, or Stivarga Regorafenib, are pill options that have their own unique side effects, but can be effective disease stabilizing drugs.