EGFR Inhibition in RAS Wild-Type Unresectable mCRC

Aggressive systemic therapy should be administered for symptomatic patients with unresectable, RAS wild-type metastatic colorectal cancer, states Fortunato Ciardiello, MD, PhD. Possible chemotherapy regimens include FOLFIRI (fluorouracil, leucovorin, and irinotecan) or FOLFOX (fluorouracil, leucovorin, and oxaliplatin). An anti—EGFR monoclonal antibody, either cetuximab or panitumumab, may be used for 3 months if the individual’s disease is RAS wild-type, adds Dirk Arnold, MD, PhD. The efficacy and toxicity is similar between the therapies, says Ciardiello.

Anti—EGFR therapy is often continued until a good response is achieved as long as the patient is tolerating the therapy, notes Ciardiello. Current data are insufficient to support treating a patient for many years with anti-EGFR therapy, if there is no disease relapse.

FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) plus bevacizumab, cetuximab, or panitumumab could be a strategy that offers short and intense cytotoxic treatment for tumor shrinkage. However, FOLFOXIRI should not be given alone for extended periods of time, adds Ciardiello.