Dr. Ruff on Selecting Anti- Angiogenic Agents in mCRC

Paul Ruff, MD, director of Medical Oncology at the University of Witwatersrand, Johannesburg, South Africa, elaborates on factors that can be utilized to select an appropriate antiangiogenic therapy as a second-line treatment in metastatic colorectal cancer (mCRC).

Whether to switch from bevacizumab to aflibercept in the second-line of treatment for patients with mCRC is an important concept that warrants further investigation. This remains particularly clear with recent evidence suggesting that switching the chemotherapy backbone while continuing bevacizumab in the second-line manifests in more efficacious results, Ruff suggests.

The antiangiogenic therapy utilized can be personalized on an individual basis, Ruff notes. As an example, patients who progress slowly on first-line bevacizumab plus chemotherapy are better candidates for continuing this regimen. In this case, aflibercept should be reserved for later lines of treatment. However, for patients with more aggressive, rapidly progressive disease a switch to aflibercept in the second-line may be warranted.  

While no formal comparison currently exists, Ruff states, aflibercept may be more appropriate for actively progressing patients with mCRC in the second-line setting than bevacizumab.

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