Tannaz Armaghany, MD, gastrointestinal medical oncologist and an assistant professor in Internal Medicine, Hematology and Medical Oncology, at Baylor College of Medicine, discusses the utility of circulating tumor (ct)DNA in colorectal cancer (CRC).

ctDNA has previously been used in the field of CRC and has shown promise, says Armaghany. For example, there was a publication where ctDNA was examined prior to and following the administration of neoadjuvant chemotherapy, radiation, and surgery patients with CRC. Although that was a small trial, it showed a signal indicating that patients whose ctDNA persists may be high risk for developing metastatic disease to begin with. This may also help with follow-up in the clinic and identifying when tumors will show up as metastatic disease, concludes Armaghany. 

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Tannaz Armaghany, MD, discusses the utility of circulating tumor DNA in colorectal cancer.

Dr. Armaghany on the Utility of ctDNA in CRC

Tannaz Armaghany, MD, an assistant professor, Internal Medicine, Hematology and Medical Oncology, at Baylor College of Medicine, discusses sorafenib (Nexavar) versus lenvatinib (Lenvima) as first-line therapy for patients with hepatocellular carcinoma (HCC).

Sorafenib is still the first-line standard option for HCC, says Armaghany. However, the phase III REFLECT trial, which compared sorafenib versus lenvatinib, demonstrated that lenvatinib is noninferior but not statistically superior to sorafenib for overall survival (OS), says Armaghany. Results showed that the median OS with lenvatinib was 13.6 months versus 12.3 months with sorafenib (HR, 0.92; 95% CI, 0.79-1.06).

Although sorafenib and lenvatinib can both be used for the first-line treatment of patients with unresectable HCC, there are situations in which it may be more beneficial to use lenvatinib, says Armaghany. For example, if a good response is needed from a patient who is symptomatic, lenvatinib may be the preferred option, due to its favorable response rate of about 40%; sorafenib only has a response rate in the single digits, explains Armaghany.

The other differentiating factor among the agents are their toxicity profiles, adds Armaghany. Hypertension occurs more often with lenvatinib; however, hand—foot syndrome is more common with sorafenib. Additionally, some early data suggest that sorafenib could potentially be more effective in patients with hepatitis C, whereas lenvatinib may have more activity in patients with hepatitis B, concludes Armaghany.

Tannaz Armaghany, MD, discusses sorafenib versus lenvatinib as first-line therapy for patients with hepatocellular carcinoma.

Dr. Armaghany on Frontline Sorafenib Versus Lenvatinib in Unresectable HCC

Tannaz Armaghany, MD, an assistant professor, Internal Medicine, Hematology and Medical Oncology, at Baylor College of Medicine, discusses the importance of NCI-MATCH trial in colorectal cancer (CRC).

The NCI-MATCH trial was created as a way to increase the efficiency of basket trials and umbrella trials, according to Armaghany. In the trial, patients will undergo genomic sequencing. The treatment arm patients are assigned to will be based on the results of their genomic profile rather than their tumor type, explains Armaghany.

Patients with advanced solid tumors, lymphomas, or myeloma who have progressed on standard therapy or those with rare cancers for which there is no standard therapy available may be eligible for enrollment. The trial could expedite the drug discovery process and enhance the treatment pipeline in oncology, which is of great importance in an aggressive malignancy such as mCRC, concludes Armaghany.

Tannaz Armaghany, MD, discusses the importance of NCI-MATCH trial in colorectal cancer.

Dr. Armaghany on the Importance of the NCI-MATCH Trial in CRC

Tannaz Armaghany, MD, an assistant professor at Baylor College of Medicine, discusses up-front gene sequencing in patients with colorectal cancer (CRC).

In the past, metastatic CRC was often considered as 2 diseases, those with 

 mutations and those with wild-type disease, but with trials such as NCI-MATCH, more targets have emerged, explains Armaghany. While 

 mutations are the most prominent in this space, presenting in about 50% of all patients, 

 fusions have also been identified in patients with CRC.

As such, when genotyping cancer cells, it is better to do a broad panel. Gene sequencing should be done up front, according to Armaghany, because the presence of these targets will impact the treatment patients receive. For example, patients with 

 wild-type amplifications typically do not respond to EGFR inhibitors. For this reason, up-front gene sequencing is the best course of action for patients diagnosed with CRC, concludes Armaghany.

Tannaz Armaghany, MD, discusses up-front gene sequencing in patients with colorectal cancer.

Tannaz Armaghany, MD

Articles

Dr. Armaghany on the Utility of ctDNA in CRC

Dr. Armaghany on Frontline Sorafenib Versus Lenvatinib in Unresectable HCC

Dr. Armaghany on the Importance of the NCI-MATCH Trial in CRC

Dr. Armaghany on Gene Sequencing in CRC