Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses dosing strategies in the treatment of patients with colorectal cancer (CRC).

Findings from the ReDOS study, which examined a dose-escalating strategy for regorafenib (Stivarga) administration, changed the NCCN guidelines regarding the use of that agent in patients with metastatic CRC. Now, the recommended administration of regorafenib in this patient population is a dose escalation from 80 mg/daily on days 1 to 7, to 120 mg/daily on days 8 to 14, and concluding with 160 mg/daily on days 15 to 21.

Becerra says that this study indicates that the field does not have a good grasp on regorafenib, and perhaps other agents. These findings have raised questions as to whether the maximum-tolerated dose is warranted as a standard in all patients, or if titration is a more effective method. Becerra says the ladder approach lends itself to the idea of individualization, suggesting that chemotherapy dosing should be decided on a patient-by-patient basis.

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Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses dosing strategies in the treatment of patients with colorectal cancer.
 

Dr. Becerra Discusses Dosing Strategies in CRC

Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses an investigational cellular therapy in colorectal cancer (CRC).

Cellular therapies are starting to be investigated in patients with CRC. Becerra says that there is a trial of natural killer (NK) cells, which are a part of the human immune system. NKs attack foreign invaders, Becerra explains, and provide a first line of defense for the immune system. There is a subset of these cells that have antitumor activity in patients who have been exposed to cytomegalovirus. This cellular therapy is being test in patients with CRC, as well as other solid tumors.

Cellular therapy is not widely used in patients with CRC, and but there are a few immunotherapeutic agents that are approved for the treatment of these patients. In May 2017, pembrolizumab (Keytruda) was approved by the FDA the treatment of adult and pediatric patients with unresectable or metastatic, microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) solid tumors that have progressed after prior treatment and for patients who have no satisfactory alternative treatment options. Nivolumab (Opdivo) subsequently was approved in August 2017 for the treatment of adult and pediatric patients with MSI-H or dMMR metastatic CRC who progressed following treatment with fluoropyrimidine, oxaliplatin, and irinotecan.

Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses an investigational cellular therapy in colorectal cancer.
 

Dr. Becerra Discusses an Investigational Cellular Therapy in CRC

Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses sequencing therapies in the treatment of patients with pancreatic cancer.

Currently, physicians do not have a head-to-head comparison between the different therapeutic agents. Therefore, in younger patients with a robust performance status there is a trend to treat patients with FOLFIRINOX, which is a 3-drug combination regimen, explains Becerra.

In older patients who are not as robust, there is a tendency to treat them with gemcitabine and nab-paclitaxel (Abraxane) first. Upon disease progression, physicians can switch to an alternative regimen. If a physician starts with gemcitabine and nab-paclitaxel and the patient's tumor gets worse, they can consider adding or changing to either FOLFIRINOX if the patient still has a very good performance status, or a variation such as FOLFOX, says Becerra. Another regimen that can be utilized is liposomal irinotecan in combination with 5-fluorouracil, which is approved as second-line chemotherapy in this particular setting, states Becerra.

Dr. Becerra on Sequencing Therapies in Pancreatic Cancer

Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses regorafenib (Stivarga) dosing in the treatment of patients with metastatic colorectal cancer (mCRC).

The phase II ReDOS study of regorafenib in patients with mCRC demonstrated that a weekly dose-escalation schedule of the oral multikinase inhibitor was superior to the previously standard starting dose of 160 mg. The findings from this trial led to the NCCN changing their guidelines on the use of regorafenib in this patient population.

Becerra says that this is a very difficult population to treat, as their disease is highly resistant. Before ReDOS, patients who were started at the standard 160 mg dose often had to pause or discontinue treatment due to the toxicities. One of the questions going into ReDOS was whether starting at a lower dose would still deliver the same benefit. ReDOS showed that starting at 80 mg, observing the tolerance, and then escalating if appropriate, led to a dramatic increase in overall survival, Becerra says.

Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses regorafenib (Stivarga) dosing in the treatment of patients with metastatic colorectal cancer.
 

Dr. Becerra Discusses Regorafenib Dosing in Metastatic CRC

Carlos Becerra, MD, physician, Texas Oncology, discusses emerging treatments for patients with pancreatic cancer.

Pancreatic cancer is one of the leading cancer-related deaths, states Beccera. There are currently no good treatment options, although progress has been made.

According to Beccera, newer chemotherapeutic agents and sequencing studies have helped to improve the field. Additionally, the new era of targeted therapy and immunotherapy will provide additional benefit that is needed for patients with metastatic pancreatic cancer.

Dr. Becerra on Emerging Treatments in Pancreatic Cancer

Carlos Becerra, MD, physician, Texas Oncology, discusses a study examining the combination of ribociclib and letrozole in patients with ER-positive, HER2-negative advanced breast cancer.

To enroll on the trial, patients must have progressed on estrogen receptor inhibitors, Becerra explains. Patients were treated with the combination to determine whether treatment with the CDK 4/6 inhibitor would prevent resistance to letrozole.

Results showed that the combination demonstrated clinical activity as well as an acceptable safety profile in patients, with an overall response rate of 39%.

Carlos Becerra, MD

Articles

Dr. Becerra Discusses Dosing Strategies in CRC

Dr. Becerra Discusses an Investigational Cellular Therapy in CRC

Dr. Becerra on Sequencing Therapies in Pancreatic Cancer

Dr. Becerra Discusses Regorafenib Dosing in Metastatic CRC

Dr. Becerra on Emerging Treatments in Pancreatic Cancer

Dr. Becerra on Ribociclib/Letrozole in ER+/HER2- Breast Cancer