Dr. Morse on Managing Toxicities and Sequencing Agents in mCRC

Michael A. Morse, MD, professor, Medicine, Department of Surgery, Duke University School of Medicine, Duke Cancer Institute, discusses factors that should be taken into consideration when sequencing agents in metastatic colorectal cancer (mCRC).

In the frontline setting, physicians have a choice of different chemotherapy drugs depending on which toxicities take precedence over others. Physicians also have biologic agents available for RAS wild-type, left-sided tumors.

There are also effective second-line therapies. Oral agents are generally reserved for later-line treatments. These include trifluridine/tipiracil (TAS-102; Lonsurf) or regorafenib (Stivarga), which have very different side-effect profiles. TAS-102 predominantly results in neutropenia and some gastrointestinal effects. Regorafenib shows diarrhea, fatigue, and occasional lesions found in hand-foot syndrome.

One of the challenges with regorafenib is keeping patients on the therapy. Physicians have to determine which drug a patient is likely to tolerate better and which drug a patient is able to comply with on a regular basis. It ultimately boils down to managing toxicities, so patients can go on to another therapy if they progress.