Dr. Overman on Second-Line Therapy Options for Colorectal Cancer

Michael J. Overman, MD, professor in the Department of Gastrointestinal Medical Oncology of the Division of Cancer Medicine and committee vice chair at The University of Texas MD Anderson Cancer Center, discusses second-line therapy options for patients with colorectal cancer.

At time of progression, standard second-line chemotherapy options are available depending on what was used in the frontline setting, says Overman. For example, if an oxaliplatin-based therapy was used in the frontline, often irinotecan can be used in the second-line. If a triplet composed of fluoropyrimidine, irinotecan, and oxaliplatin was used in the frontline, these agents can be reintroduced at the time of progression, after maintenance therapy, according to Overman.

For molecular subtypes, such as tumors harboring HER2 or BRAF alterations, or in those with mismatch repair deficiency, targeted therapies can be used in the second-line setting, says Overman. It is important to test for these mutations early on in the treatment journey as that information can be used to inform future treatment decisions.

In the third- and fourth-line refractory setting, oral agents, such as regorafenib (Stivarga) or TAS-102 (trifluridine/tipiracil; Lonsurf), can be used, adds Overman. Clinical trials are always an option as well, concludes Overman.