Dr. Mahipal on Treatment of Newly Diagnosed mCRC

Amit Mahipal, MBBS, professor of medicine, Mayo Clinic, discusses the treatment of patients with newly diagnosed metastatic colorectal cancer (mCRC).

This treatment paradigm has changed a lot in the past decade, Mahipal says. The current standard of care is to give a chemotherapy backbone with a biologic agent. The chemotherapy is usually comprised of either FOLFOX, XELOX, or FOLFIRI, but some patients will receive single-agent fluoropyrimidine or a more aggressive treatment, like FOLFOXIRI. The majority of patients will receive bevacizumab (Avastin) with their chemotherapy, but select patients who are eligible for EGFR therapy will receive panitumumab (Vectibix) or cetuximab (Erbitux).

Combinations are based on tumor-related factors as well as patient factors, Mahipal says. Examples of patient factors include: age, comorbidities, performance status, as well as pre-existing toxicity. Recently, rare biomarkers like BRAF, RAS, HER2, RAF, and microsatellite instability status have become an important part of driving treatment decisions.