Dr. Eckhardt on Angiogenesis Inhibition in Metastatic CRC

S. Gail Eckhardt, MD, Professor and Head of the Division of Medical Oncology at the University of Colorado Denver and Health Sciences Center, discusses the role of angiogenesis inhibitors in the treatment of metastatic colorectal cancer (mCRC), following the approval of aflibercept.

Eckhardt notes that she has not administered the angiogenesis inhibitor aflibercept, not because of bias, but rather due to a lack of a formal comparison to the established angiogenesis inhibitor bevacizumab. Each of these agents possesses a unique toxicity profile in addition to the toxicity associated with the chemotherapy that is co-administered, Eckhardt notes. As such, new side effect management techniques would be required when utilizing each angiogenesis inhibitor.

Without a formal comparison to bevacizumab, Eckhardt remains unsure where to position aflibercept in the treatment sequence for patients with mCRC. There is evidence that bevacizumab works beyond progression, Eckhardt notes, but it remains unclear if aflibercept possesses these same properties. However, clinical trials have shown that aflibercept is effective following bevacizumab. As such, it may be an ideal choice as a second-line treatment.

There are data suggesting that agents targeting angiogenesis can be moved around in the sequence during the treatment of renal cell carcinoma, Eckhardt points out. However, this approach has not been examined for patients with colorectal cancer.