Dr. Messersmith on Choosing a Treatment Option in mCRC

Wells A. Messersmith, MD, co-leader of the Developmental Therapeutics Program, and director, GI Cancer Program, and professor of medicine, at the University of Colorado School of Medicine, discusses therapeutic options in metastatic colorectal cancer (mCRC) and what factors help determine the most appropriate option.

Trials exploring first- and second-line treatment strategies in mCRC have been plentiful over the past few years, Messersmith says.

In the first-line setting, bevacizumab (Avastin) has shown a benefit across patient populations. As reported in the phase III CRYSTAL trial (NCT00154102) and the phase III PRIME study (NCT00364013), EGFR inhibitors have also shown benefit in the frontline metastatic setting.

Antiangiogenesis inhibitors like ziv-aflibercept (Zaltrap) and ramucirumab (Cyramza) can also be utilized in the second-line setting.

Determining which therapy to use in which patient depends on a variety of factors including which side the tumor is on. Notably, right-sided tumors and left-sided tumors have a different embryonic origin and must be treated differently. Moreover, microsatellite status and presence of molecular markers like KRAS, NRAS and BRAF have to be taken into account, states Messersmith.