Tanios S. Bekaii-Saab, MD, FACP, medical oncologist, medical director, Cancer Clinical Research Office, vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discusses the toxicity differences between regorafenib (Stivarga) and trifluridine/tipiracil (TAS-102; Lonsurf) in colorectal cancer (CRC).

Regorafenib and TAS-102 have demonstrated similar efficacy in the third-line setting for patients with CRC, says Bekaii-Saab. Moreover, because the agents have not been compared head-to-head, selecting between regorafenib and TAS-102 is largely driven by toxicity, as well as physician preference, Bekaii-Saab explains. 

Regarding safety, TAS-102 may be better tolerated vs regorafenib, particularly at the beginning of treatment, Bekaii-Saab says. Toxicities tend to emerge later with TAS-102, especially in patients who are responding to the therapy. Conversely, significant toxicities can occur within the first 2 weeks of treatment with regorafenib, Bekaii-Saab says. As such, implementing a dose-escalation approach with regorafenib may improve tolerability, concludes Bekaii-Saab.

Videos

Tanios S. Bekaii-Saab, MD, FACP, discusses the toxicity differences between regorafenib and trifluridine/tipiracil in colorectal cancer.  



Dr. Bekaii-Saab on the Toxicity Differences Between Regorafenib and TAS-102 in CRC 

Tanios S. Bekaii-Saab, MD, FACP, medical oncologist, medical director, Cancer Clinical Research Office, vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discusses indicators of progression in colorectal cancer (CRC).

Indicators of progression fit together like a puzzle to determine whether a patient has progressed and requires additional treatment, says Bekaii-Saab. Three main factors should be considered when determining progression: the patient’s symptoms, the results of their most recent scan, and their cancer markers. 

An increase in patient symptoms, including weight loss and pain, is a key indication of progression and should be relied on most, explains Bekaii-Saab. Scan results should be given second-highest priority, followed by changes in cancer markers, Bekaii-Saab adds. For example, a patient who has an inconclusive scan but is experiencing significant symptoms likely has disease progression. Conversely, a patient with minimal symptoms and clear scans whose cancer markers are increasing may not require subsequent therapy, concludes Bekaii-Saab. 

Tanios S. Bekaii-Saab, MD, FACP, discusses indicators of progression in colorectal cancer.  



Dr. Bekaii-Saab Discusses Indicators of Progression in CRC 

Tanios S. Bekaii-Saab, MD, FACP, medical oncologist, medical director, Cancer Clinical Research Office, vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discusses incorporating potential mechanisms of resistance into treatment selection in hepatocellular carcinoma (HCC).

Currently, patterns of resistance among patients with HCC remain largely misunderstood, Bekaii-Saab explains. However, theoretical and extrapolated data suggest that mechanisms of resistance will be important considerations in HCC.

In HCC, single-agent and combination strategies targeting the VEGF pathway have been significant advances that have led to improved outcomes for patients. Notably, after standard of care atezolizumab (Tecentriq) plus bevacizumab (Avastin) in the first-line setting, patients may receive cabozantinib (Cabometyx) or regorafenib (Stivarga) in the second line, Bekaii-Saab explains. Although both agents offer reasonable options, cabozantinib could theoretically be preferred to regorafenib because MET/AXL are known mechanisms of resistance to VEGF, concludes Bekaii-Saab.

Tanios S. Bekaii-Saab, MD, FACP, discusses incorporating potential mechanisms of resistance into treatment selection in hepatocellular carcinoma.  



Dr. Bekaii-Saab on Incorporating Mechanisms of Resistance Into Treatment Selection in HCC 

Tanios S. Bekaii-Saab, MD, FACP, leader of the Gastrointestinal Cancer Program at Mayo Clinic Cancer Center; a medical oncologist, director of the Cancer Clinical Research Office, and the vice chair and section chief for Medical Oncology in the Department of Internal Medicine at the Mayo Clinic, discusses second-line treatment options in hepatocellular carcinoma (HCC).

When thinking about all the first-line treatment options available in HCC, such as atezolizumab (Tecentriq) and bevacizumab (Avastin), the question becomes focused on which options should be used in the second-line setting, says Bekaii-Saab. Several second-line options have emerged in recent years and they all came on the heels of sorafenib (Nexavar), adds Bekaii-Saab. The field does not have much data available to inform what should be done following first-line treatment.

Today, the options in the second-line setting are regorafenib (Stivarga), cabozantinib (Cabometyx), and ramucirumab (Cyramza) if your alpha-fetoprotein is ≥400 ng/mL. Ipilimumab (Yervoy) and nivolumab (Opdivo) are also available, along with pembrolizumab (Keytruda). It has been suggested that sorafenib and lenvatinib (Lenvima) could potentially move to the second-line setting, although at this point in time, there are not enough data available to support either of those agents beyond the first-line setting, concludes Bekaii-Saab.

Tanios S. Bekaii-Saab, MD, FACP, discusses second-line treatment options in hepatocellular carcinoma.

Dr. Bekaii-Saab on Second-Line Treatment Options in HCC

OncLive On Air is a podcast from OncLive, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, OncLive covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.

But today, we had the pleasure of sitting down with Tanios Bekaii-Saab, MD, FACP, who is a medical oncologist, and medical director of the Cancer Clinical Research Office, vice chair and section chief of Medical Oncology in the Department of Internal Medicine, at Mayo Clinic. Saab is also on the selection committee for the OncLive Giants of Cancer Care program.

He has been a leading oncologist in the gastrointestinal cancers field, and has spearheaded several research efforts that have impacted clinical practice. such as the phase II ReDOS trial, which evaluated a weekly regorafenib dose-escalation strategy beginning at 80 mg and ending at 160 mg. Results showed that the approach was appropriate and potentially optimal for previously treated patients with metastatic colorectal cancer.

In our exclusive interview, Dr. Bekaii-Saab spent time discussing the path to practicing in gastrointestinal malignancies, how he navigates balancing his professional and personal life, and mottos he has lived by throughout his career and while caring for his patients.

Podcasts

Dr. Tanios Bekaii-Saab spent time discussing the path to practicing in gastrointestinal malignancies, how he navigates balancing his professional and personal life, and mottos he has lived by throughout his career and while caring for his patients.

Tanios Bekaii-Saab, MD: Not Just Seeing the Light, But Getting Out of the Tunnel

Tanios Bekaii-Saab, MD, FACP, medical oncologist, medical director, Cancer Clinical Research Office, vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discusses the clinical implications of the results of the phase III POLO trial in metastatic pancreatic cancer.

 mutations are very sensitive to platinum-based therapy, explains Bekaii-Saab. However, patients who are exposed to long-term platinum-based chemotherapy develop neuropathy, he says. In the POLO trial, patients with metastatic pancreatic cancer, after ≥16 weeks of first-line platinum-based chemotherapy, received either olaparib (Lynparza) or placebo as a maintenance treatment after the last chemotherapy dose.

The primary endpoint of the study was progression-free survival (PFS) and the secondary endpoint was overall survival (OS). The median PFS by investigator assessment for olaparib was 13.2 months versus 9.2 months for placebo. At an interim analysis, the OS was 18.9 months for olaparib and 18.1 months for placebo. This study demonstrates PARP inhibitors have a role in the maintenance setting of this disease, according to Bekaii-Saab.

Tanios Bekaii-Saab, MD, FACP, discusses the clinical implications of the results of the phase III POLO trial in metastatic pancreatic cancer.

Tanios Bekaii-Saab, MD, FACP

Articles

Dr. Bekaii-Saab on the Toxicity Differences Between Regorafenib and TAS-102 in CRC

Dr. Bekaii-Saab Discusses Indicators of Progression in CRC

Dr. Bekaii-Saab on Incorporating Mechanisms of Resistance Into Treatment Selection in HCC

Dr. Bekaii-Saab on Second-Line Treatment Options in HCC

Tanios Bekaii-Saab, MD: Not Just Seeing the Light, But Getting Out of the Tunnel

Dr. Bekaii-Saab on POLO Trial Results in Pancreatic Cancer