Johanna C. Bendell, MD, medical oncologist, Sarah Cannon Research Institute, discusses the next steps following progression on checkpoint inhibitors in microsatellite instability-high (MSI-H) colorectal cancer (CRC).

For patients with MSI-H disease, they can still have the general standard chemotherapies that are still available to them, as well as targeted agents following progression on checkpoint inhibitor therapy, explains Bendell.

If a patient progresses on the checkpoint inhibitor, they could potentially go on to regorafenib (Stivarga), TAS-102 (Lonsurf), or a clinical trial. According to Bendell, there are many clinical trials that are looking at combinations for patients who have progressive disease following single-agent immunotherapies.

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Dr. Bendell on the Next Steps Following Progression on Immunotherapy in MSI-H CRC

Johanna C. Bendell, MD, medical oncologist, Sarah Cannon Research Institute, discusses pembrolizumab (Keytruda) in colorectal cancer (CRC).

Pembrolizumab is currently approved for any patient with a microsatellite instable tumors, including CRC. This is the first time that the FDA has approved an agent based on a biomarker, as opposed to a tumor type, says Bendell.

Johanna C. Bendell, MD, medical oncologist, Sarah Cannon Research Institute, discusses pembrolizumab (Keytruda) in colorectal cancer.

Dr. Bendell Discusses Pembrolizumab in CRC

Johanna C. Bendell, MD, medical oncologist, Sarah Cannon Research Institute, discusses the treatment of patients with colorectal cancer (CRC) that are microsatellite stable (MSS).

Bendell says that 95% of patients with metastatic CRC are not microsatellite high, and treatments for them must be developed. Preliminary results of combinations with immunotherapy have shown promising response rates.

The combination of the PD-1 inhibitor atezolizumab (Tecentriq) with the MEK inhibitor cobimetinib (Cotellic) showed impressive preliminary results, and the combination has now moved into a randomized phase III global study.

Johanna C. Bendell, MD, medical oncologist, Sarah Cannon Research Institute, discusses the treatment of patients with colorectal cancer (CRC) that are microsatellite stable.
 

Dr. Bendell on the Treatment of Microsatellite Stable Patients With CRC

Johanna C. Bendell, MD, medical oncologist, Sarah Cannon Research Institute, discusses the future of regorafenib (Stivarga) for patients with colorectal cancer (CRC).

Further studies need to be done to determine the best dosage for regorafenib because most patients cannot tolerate the current dose, says Bendell.

A current trial conducted by researchers out of Mayo Clinic is comparing the full dosage to a lower dosage to see if tolerability will translate into increased progression-free survival, explains Bendell.

Dr. Bendell on the Future of Regorafenib for Patients With CRC

Johanna C. Bendell, MD, director of GI Oncology Research at Sarah Cannon Research Institute, discusses the FDA approval of regorafenib (Stivarga) for the treatment of patients with hepatocellular carcinoma (HCC).

Dr. Bendell on FDA Approval of Regorafenib in Liver Cancer

Johanna C. Bendell, MD, director of GI Oncology Research at Sarah Cannon Research Institute, discusses the remaining questions researchers have with regorafenib (Stivarga) for patients with hepatocellular carcinoma (HCC).

The biggest thing with regorafenib, Bendell says, is how to dose it safely and how to limit the associated toxicities that are observed. The current starting dose is 160 mg daily, but if physicians administer that dose they should educate patients about the toxicities. Patients should also report any related adverse events immediately so physicians can hold treatment before it becomes intolerable.

Some practitioners, though, are starting at lower doses, such as 120 mg or even 80 mg, she says.

Dr. Bendell on Remaining Questions With Regorafenib in HCC

Johanna C. Bendell, MD, director of GI Oncology Research at Sarah Cannon Research Institute, discusses exciting research and advancements in the field of hepatocellular carcinoma (HCC).

Researchers in the field have known that drugs that block the angiogenesis pathway for patients with HCC, such as sorafenib (Nexavar), do work for these patients, Bendell explains. However, data presented from the phase III RESORCE trial show that the multikinase inhibitor regorafenib (Stivarga) also has a benefit in this population.

Immunotherapies are also agents with potential, she adds. In liver cancer, investigators have looked at checkpoint inhibitors like anti&shy;—PD-1/PD-L1 agents alone and in combination with CTLA-4 inhibitors. These types of combinations are currently being explored in clinical trials; moreover, they are showing particular potential in patients with hepatitis C.

Johanna C. Bendell, MD, director of GI Oncology Research at Sarah Cannon Research Institute, discusses exciting research and advancements in the field of hepatocellular carcinoma.

Johanna C. Bendell, MD

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