Nilofer S​aba Azad, MD, associate professor of oncology, Johns Hopkins ​University School of Medicine, ​director, Developmental Therapeutics Clinical Trials Program, Johns Hopkins Sidney Kimmel Cancer Center, discusses selecting between regorafenib (Stivarga) and TAS-102 (trifluridine/tipiracil; Lonsurf) in colorectal cancer (CRC).

Largely, the decision to select regorafenib or TAS-102 as third- and fourth-line treatment options for patients with CRC is provider dependent, says Azad. 

The agents have demonstrated overlapping survival curves, so they are similar in terms of efficacy, Azad explains. However, ease of dosing and patient tolerability can inform which therapy is optimal for a patient.

For Azad, TAS-102 appears to be more tolerable for patients compared with regorafenib. Additionally, randomized data have shown promising efficacy with the combination of TAS-102 and bevacizumab (Avastin), says Azad.

Additionally, data showed that patients who received TAS-102 were able to maintain their fitness and performance status better versus placebo. A similar analysis was not conducted with regorafenib, concludes Azad.

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Nilofer S​aba Azad, MD, discusses selecting between regorafenib and TAS-102 in colorectal cancer.  


Dr. Azad on Selecting Between Regorafenib and TAS-102 in CRC 

Nilofer S​aba Azad, MD, associate professor of oncology, Johns Hopkins ​University School of Medicine, ​director, Developmental Therapeutics Clinical Trials Program, Johns Hopkins Sidney Kimmel Cancer Center, discusses third-line treatment options for patients with colorectal cancer (CRC).

 wild-type CRC can receive EGFR inhibitors, Azad says. 

Additionally, patients whose tumors harbor a 

 mutation should be treated with a BRAF inhibitor in combination with an EGFR inhibitor, explains Azad. 

For the general population of patients with CRC, treatment selection is between TAS-102 (trifluridine/tipiracil; Lonsurf) and regorafenib (Stivarga) in the third-line setting, concludes Azad. 

Nilofer S​aba Azad, MD, discusses third-line treatment options for patients with colorectal cancer.  



Dr. Azad on Third-Line Treatment Options in CRC 

Nilofer S​aba Azad, MD, associate professor of oncology, Johns Hopkins ​University School of Medicine, ​director, Developmental Therapeutics Clinical Trials Program, Johns Hopkins Sidney Kimmel Cancer Center, discusses future research efforts in colorectal cancer (CRC).

The CRC space is entering an exciting era wherein a number of potential treatment strategies are beginning to surface, explains Azad.

For example, novel immunotherapy strategies are being evaluated, with the goal of making immunotherapy effective for all patients with CRC, Azad explains.

 Moreover, several targeted agents and chemotherapy regimens continue to be explored in clinical trials, Azad says.

It is unlikely that all ongoing research efforts will lead to positive findings. However, it is important that patients continue to enroll on clinical trials, Azad concludes.

Nilofer S​aba Azad, MD, discusses future research efforts in colorectal cancer. 

Dr. Azad on Future Research Efforts in CRC    

Nilofer S​aba Azad, MD, associate professor of oncology, Johns Hopkins ​University School of Medicine, ​director, Developmental Therapeutics Clinical Trials Program, Johns Hopkins Sidney Kimmel Cancer Center, discusses the significance of germline testing in colorectal cancer (CRC).

Hereditary nonpolyposis CRC or Lynch syndrome is present in 1% to 2% of patients​, says Azad. However, it is the most common hereditary cancer syndrome and is associated with an increased risk of developing CRC, as well as other cancers.

 ​Notably, broad molecular testing for hereditary syndromes by genetic counselors can result in earlier detection of associated cancers at more treatable stages​, Azad explains.

Despite the rarity of this genetic syndrome, families that have a strong history of cancer, as well as individuals who are diagnosed with CRC under the age of 50, should undergo germline genetic ​testing, Azad concludes.

Nilofer S​aba Azad, MD, discusses the significance of germline testing in colorectal cancer. 

Dr. Azad on the Importance of Germline Testing in CRC

Nilofer S​aba Azad, MD, associate professor oncology, Johns Hopkins ​University School of Medicine, ​director, Developmental Therapeutics Clinical Trials Program, Johns Hopkins Sidney Kimmel Cancer Center, discusses treatment considerations in right- versus left-sided colorectal cancer (CRC).

In the CRC space, epidemiological studies have shown that patients with right-sided tumors have more aggressive and potentially resistant disease versus patients with left-sided tumors, Azad says.

Historically, these biological differences were not used to inform treatment selection, explains Azad. Patients with right- and left-sided tumors received the same course of treatments. 

However, in the past few years, a series of trials indicated that tumor sidedness does influence response to treatment, Azad says.

Moreover, patients with right-sided tumors appear to respond better to aggressive chemotherapy compared with patients with left-sided tumors, says Azad. Conversely, patients with metastatic disease and left-sided tumors that do not harbor 

 mutations may benefit from EGFR inhibitors in the frontline setting. 

Nilofer S​aba Azad, MD, discusses treatment considerations in right- versus left-sided colorectal cancer.  



Dr. Azad on Treatment Considerations in Right- Versus Left-Sided CRC 

Nilofer S​aba Azad, MD, associate professor oncology, Johns Hopkins ​University School of Medicine, ​director, Developmental Therapeutics Clinical Trials Program, Johns Hopkins Sidney Kimmel Cancer Center, discusses remaining challenges in colorectal cancer (CRC).

Ongoing efforts are spotlighting the importance of ​cancer screening. As a result, progress is being made in lowering the incidence of CRC​, Azad explains.

Additionally, several regulatory approvals in the advanced disease setting ​have expanded the armamentarium after many years of stagnation, Azad says.

However, despite the addition of these newer agents, patients with advanced CRC continue to derive modest benefits from treatment. ​Although the survival advantage that these agents have demonstrated in the space is encouraging, additional research needs to be done to make CRC a chronic disease, concludes Azad.

Nilofer S​aba Azad, MD, discusses remaining challenges in colorectal cancer. 








Nilofer Saba Azad, MD

Articles

Dr. Azad on Selecting Between Regorafenib and TAS-102 in CRC

Dr. Azad on Third-Line Treatment Options in CRC

Dr. Azad on Future Research Efforts in CRC

Dr. Azad on the Importance of Germline Testing in CRC

Dr. Azad on Treatment Considerations in Right- Versus Left-Sided CRC

Dr. Azad on Remaining Challenges in CRC