Dr. Bekaii-Saab on the Challenges of Utilizing Chemotherapy-Free Regimens in CRC

Tanios S. Bekaii-Saab, MD, FACP, medical oncologist, medical director, Cancer Clinical Research Office, vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discusses the challenges of utilizing chemotherapy-free regimens in colorectal cancer (CRC).

Chemotherapy-free options in CRC comprise biologic therapies or treatment-free intervals, says Bekaii-Saab. Generally, first- and second-line therapies for patients with CRC consist of intensive chemotherapy with FOLFOX, FOLFIRI, or FOLFOXIRI, Bekaii-Saab explains.

A systematic review and network meta-analysis of 12 randomized clinical trials of patients with metastatic CRC suggested that maintenance therapy with a fluoropyrimidine plus or minus bevacizumab (Avastin) is preferred vs continuous induction therapy in this patient population. However, because no significant survival benefits have been demonstrated with maintenance therapy in this setting, observation is a relevant option to consider. 

As such, patients who want a treatment-free interval may not experience a worse survival, but their disease will likely progress rapidly, explains Bekaii-Saab. Ultimately, shared-decision making with the provider and patient is needed to determine the optimal treatment approach for the individual, says Bekaii-Saab.

In the later-line settings, regorafenib (Stivarga) remains the only chemotherapy-free option for patients with CRC, concludes Bekaii-Saab.