Dr Dasari on Salvage Treatment Considerations for Unresectable Metastatic CRC

Arvind N. Dasari, MD, MS, associate professor, the Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, discusses later-line therapies considerations in unresectable metastatic colorectal cancer (mCRC).

Resistance to standard treatments including cytotoxic agents like 5-fluorouracil (5-FU), irinotecan, oxaliplatin, and targeted therapies like anti-BRAF, anti-HER2, and anti-EGFR agents is common in patients with unresectable mCRC, Dasari begins. As such, identifying appropriate salvage therapies becomes critical upon progression, he states.

Prior to data from the phase 3 FRESCO-2 trial (NCT04322539), which in turn led to the 

, patients few salvage therapy agents available in this treatment setting, including regorafenib (Stivarga) and trifluridine/tipiracil (TAS-102; Lonsurf), Dasari reports.

Dasari emphasizes that fruquintinib has expanded the landscape of later-line treatment options for refractory mCRC, offering an additional therapeutic avenue for patients who have exhausted previous lines of therapy. This represents a novel therapeutic approach for patients with mCRC who are truly refractory to all available therapies, he explains.

When deciding several factors must guide the selection of salvage therapy, including patient comorbidities, prior treatment history and associated toxicities, and disease burden, Dasari continues. For instance, liver health is a key factor since the liver is the most common site of metastasis in mCRC; the choice of therapy could be influenced by the patient's hepatic function and reserve. Patient preferences also play a crucial role, particularly when considering the route of administration, whether that be oral or intravenous, to minimize time in infusion centers.

Additionally, the cumulative adverse effects from previous treatments, such as oxaliplatin-induced neurotoxicity or hematologic toxicities from multiple therapies, may restrict subsequent therapeutic options.

Later-line treatment for unresectable mCRC requires an individualized approach that takes into account clinical parameters, patient preferences, and overall quality of life, Dasari concludes. The aim is to strike a balance between efficacy and tolerability, ensuring the chosen therapy aligns with the patient's clinical status and treatment goals.

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Arvind N. Dasari, MD, MS, discusses later-line treatment considerations for patients with unresectable metastatic colorectal cancer.

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Multidisciplinary Care for Patients with CRC

Experts on colorectal cancer discuss the treatment decision-making process, highlighting the safety profiles of fruquintinib and regorafenib.

Toxicity Considerations and Treatment Decisions in CRC

Michael Leung, PharmD, presents the case of a 57-year-old man with cecal colon adenocarcinoma and provides his initial thoughts.

Patient Case 3: A 57-Year-Old Man With Cecal Colon Adenocarcinoma

Michael Leung, PharmD, presents the case of a 57-year-old man with cecal colon adenocarcinoma and provides his initial thoughts, particularly on adverse event management.

Focusing on the treatment of patients receiving regorafenib, the panel details the management of common adverse events and prophylaxis strategies.

Treatment Considerations With Regorafenib in Colorectal Cancer

Focusing on the treatment of patients receiving regorafenib, the panel details the management of common adverse events, prophylaxis strategies, and the roles of members within a multidisciplinary team.

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In today’s episode, sponsored by Taiho Pharmaceutical, John H. Strickler, MD, moderated an 

 Inside the Clinic discussion about adverse effect (AE) management for patients with colorectal cancer (CRC). Strickler is an associate professor of medicine and a member of the Duke Cancer Institute in Durham, North Carolina.

Strickler was joined by Michael Leung, PharmD, BCOP, a clinical pharmacy specialist in Gastrointestinal (GI) Medical Oncology at The University of Texas MD Anderson Cancer Center in Houston; Arvind N. Dasari, MD, MS, an associate professor in the Department of GI Medical Oncology in the Division of Cancer Medicine at MD Anderson; and Margot O’Neill, PA-C, MHS, a physician assistant in oncology at the Duke Cancer Institute. 

In our exclusive interview, the panelists discussed AE monitoring and management with trifluridine/tipiracil (Lonsurf) plus bevacizumab (Avastin) for patients with previously treated, metastatic CRC; prophylactic and reactive AE management strategies when using regorafenib (Stivarga) for patients with advanced disease; and how real-world clinical experience with fruquintinib (Fruzaqla) has driven AE management for patients with metastatic disease who are receiving this agent.

That’s all we have for today! Thank you for listening to this episode of 

, sponsored by Taiho Pharmaceutical. Check back on Mondays and Thursdays for exclusive interviews with leading experts in the oncology field.

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Strickler, Leung, Dasari, and O'Neill discuss adverse effect monitoring and management with standard agents for patients with colorectal cancer.  

Arvind N. Dasari, MD, MS

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