Dr. Eng on Recognizing Tumor Sidedness in mCRC

Cathy Eng, MD, professor of gastrointestinal medical oncology, The University of Texas MD Anderson Cancer Center, discusses the importance of recognizing tumor sidedness in the treatment of patients with metastatic colorectal cancer (mCRC).

One of the biggest recent advances that have been made in the frontline treatment for patients with mCRC has been the recognition for tumor sidedness, Eng says, as knowing which side the tumor is on can be used to inform which treatment will be most appropriate. For example, right-sided patients with metastatic disease should not receive an EGFR inhibitor.

There have been some data from the VOLFI trial which examined the role of mFOLFOXIRI plus anti—EGFR therapy in RAS wild-type patients. Eng stresses that you have to be very selective about utilizing this treatment. For a patient who is not surgically resectable, the progression-free survival data was trending in favor of this chemotherapy but it was not statistically significant. The treatment was also associated with grade 3 diarrhea, Eng says. This was a small study comprised of less than 100 patients, but it suggests a possible therapeutic option for this subset. However, Eng concludes that if she wants to use an aggressive regimen, she would give mFOLFOXIRI plus bevacizumab (Avastin).