Dr. McCollum on Frontline Therapy for Patients With Metastatic CRC

A. David McCollum, MD, oncologist, Baylor University Medical Center, discusses frontline therapy for patients with metastatic colorectal cancer (mCRC).

There are many frontline therapies for patients with mCRC. A lot of the decision comes down to sidedness and toxicity, explains McCollum. Whether the primary tumor originates in the right side of the colon or the left side of the colon will direct a physician’s choice of therapy. Data has consistently shown that patients who have right sided tumors typically do not do well with an EGFR antibody-containing regimen. Sidedness and the molecular profile of the tumor are the biggest determinants between an EGFR antibody and a VEGF antibody, explains McCollum.

Deciding which chemotherapy to combine that with comes down to patient preferences, toxicity, and provider comfort level, says McCollum. A patient who does better on a regimen that spares neuropathy will typically receive an irinotecan-containing regimen such as FOLFIRI. If a patient has experienced more gastrointestinal toxicity from the start of treatment and wants to avoid the risk of diarrhea and enteritis, a physician may opt for an oxaliplatin-based therapy, says McCollum.