Axel Grothey, MD, Professor of Oncology and Consultant in the Division of Medical Oncology in the Department of Oncology, Mayo Clinic, Rochester, Minnesota, discusses a survey that examined the perceived benefits and use of adjuvant oxaliplatin in colon cancer.

Overall, surveys were collected from 102 US-based oncologists, 25 of whom were gastrointestinal cancer clinical investigators. The surveys provided data on the treatment used for 306 patients with stage II and 102 patients with stage III colon cancer. Additionally, the microsatellite mismatch repair (MMR) and 12-gene Recurrence Scores were reported to track the efficacy of treatment.

Treatment data indicated that oxaliplatin plus fluoropyrimidine was administered to 95 patients with stage III cancer and 85 with stage II. For patients with stage II and III colon cancer, respectively, MMR was evaluated in 127 and 20 and Recurrence Scores were obtained in 46 and 2.

Overall, Grothey notes, the study found that physicians overestimate the efficacy and activity of oxaliplatin for patients with colon cancer. Moreover, oxaliplatin was used extensively despite the fact that it provided less benefit than many oncologists reported requiring using the agent. This is significant, Grothey believes, since the administration of oxaliplatin is associated with serious neurotoxicity.

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Axel Grothey, MD, from the Mayo Clinic, Rochester, Minnesota, discusses a survey that examined the perceived benefits and use of adjuvant oxaliplatin in colon cancer. 

Dr. Grothey Examines Adjuvant Oxaliplatin in Colon Cancer

Axel Grothey, MD, Professor of Oncology and Consultant in the Division of Medical Oncology in the Department of Oncology, Mayo Clinic, Rochester, Minnesota, discusses the time course of adverse events (AEs) following treatment with regorafenib, as observed in the CORRECT study.

The phase III CORRECT trial examined the oral multikinase inhibitor regorafenib following progression on standard treatments for patients with metastatic colorectal cancer. The trial found a significant overall survival prolongation of 6.4 months compared with 5.0 months in patients who received a placebo (HR = 0.77; 

 = .0052). The results were the basis for the FDA approval of the agent in September 2012 (

One of the critical issues associated with regorafenib, as a multikinase inhibitor, are the AEs, Grothey explains. The most frequent regorafenib-related side effects include: hand—foot skin reaction, fatigue, diarrhea, hypertension, and rash/desquamation.

In the safety analysis of the CORRECT trial, Grothey explains, the frequency of regorafenib-related AEs peaked during the first cycle of treatment and gradually began to taper off. This gradual decline is due in part to dose reductions, Grothey explains; however, even in patients who did not receive a reduced dose the incidence and severity of AEs still tapered off.

Grothey believes these findings indicate that special care is needed during the first cycle of treatment with regorafenib. Additionally, once the first cycle of treatment is finished regorafenib can be safely continued at a maintenance dose.

View coverage from the 2013 GI Cancers Symposium

Axel Grothey, MD, from the Mayo Clinic, Rochester, Minnesota, discusses the time course of adverse events following treatment with regorafenib, as observed in the CORRECT study.

Dr. Grothey on the Time Course of Regorafenib-Associated AEs

Axel Grothey, MD, Professor of Oncology, Consultant, Medical Oncology, Mayo Clinic, discusses the novel agents being investigated for colorectal cancer (CRC). There has not been a new agent for CRC since the approval of cetuximab and bevacizumab 7 1/2 years ago.

Recently there have been numerous advances in what was previously a very stagnant field. One of the most important discoveries is that KRAS mutated tumors do not respond to epidermal growth factor receptor (EGFR) inhibitor drugs such as cetuximab and panitumumab.

Aflibercept, a novel agent currently under investigation, binds to the VEGF-A ligand, VEGF-B, and the placental growth factor (PIGF). Adding aflibercept to FOLFIRI in metastatic CRC patients resulted in significantly improved outcomes in the second-line setting.

The oral multikinase inhibitor named regorafenib demonstrated overall survival in heavily pretreated metastatic CRC; these patients currently do not have any clinical options. The data from the phase III trial, which was stopped early because of positive data, will be released at ASCO GI 2012.

Dr. Axel Grothey from the Mayo Clinic Discusses Novel Agents for Colorectal Cancer

Dr. Grothey Discusses Novel Agents for Colorectal Cancer

Axel Grothey, MD, Professor of Oncology, Consultant, Medical Oncology, Mayo Clinic, discusses the first-line use of the targeted agent trastuzumab (Herceptin) to treat HER2-positive gastroesophageal cancer.

Trastuzumab is the first targeted agent to be used as a first-line therapy in gastroesophageal cancer. All patients with the disease should now be test for an overexpression of HER2. If patients are HER2-positive trastuzumab should be added to the standard chemotherapy, which is usually 5-fluorouracil and platinum agents such as cisplatin.

Dr. Axel Grothey from the Mayo Clinic on Trastuzumab for Gastroesophageal Cancer

Axel Grothey, MD

Articles

Dr. Grothey Examines Adjuvant Oxaliplatin in Colon Cancer

Dr. Grothey on the Time Course of Regorafenib-Associated AEs

Dr. Grothey Discusses Novel Agents for Colorectal Cancer

Dr. Grothey on Trastuzumab for Gastroesophageal Cancer