Drs. Wasif Saif and Bert H. O’Neil take on some of the most recently approved treatment methods for metastatic colo-rectal cancer (mCRC) and compare their efficacy, risks, and benefits against other treatments options — some in use for the past half-century. Colo-rectal cancer is the second leading cause of cancer death in the United States; worldwide there are nearly 1,000,000 cases. Men and women have an equal lifetime risk of the disease, but 93% of cases diagnosed are in people over the age of 50.
Dr. Bert H. O’Neil, MD from Indiana University Simon Cancer Center hosts the presentation given by Dr. Wasif Saif, MD of Tufts University School of Medicine. They discuss recent clinical trials and several case studies for personalizing treatment in this On Demand CME offering from OMEDLive.
Treatment options for mCRC
The team discusses treatment options including surgical, radiologic, cytotoxic, and targeted agents, with key considerations for personalized treatment of mCRC. Dr. Saif gives us what he considers to be important factors in the goals of therapy, and all of his choices and recommendations for personalizing treatment take these into consideration throughout the presentation.
Historically, doctors began treating mCRC in America as far back as the 1960s and although several therapies have been trialed and introduced since then, Dr. Saif said “5-FU” is still used either alone or in conjunction with other therapies. In the U.S., the Mayo Clinic Monthly approach is used as the primary regimen in academic medical facilities, while the Roswell Park Weekly approach is used more frequently in public, non-academic hospitals.
The lines of therapy for CRC as the disease develops is a complex model for treatment, but it does lend itself well to personalizing treatment. Dr. Saif said, “the most important part is when you see the patient for the first time, you need to set up in your mind what are we going to use for the first weapon to treat this cancer; what will be the second-line and third-line therapy?”
Dr.Saif discusses treatment paradigms for mCRC, with palliation with symptomatic support as the most important outcome to consider.
In personalizing treatment for metastatic colo-rectal cancer, Dr. Saif lists several patient selection criteria to reflect on what will help guide the provider and patient to optimal treatment plans. Dr. Saif added that historically patient age was the biggest factor, but now it’s shifting to performance status and comorbidities. One of the case studies featured a patient with a specific ECOG PS as one of the factors used to determine the treatment option.
Recently Approved Medications
In 2015 Ramucirumab and Trifluridin/Tipiracil were approved for use in the U.S., and Dr. Saif explains some of the uses and considerations for each. Dr. O’Neil brings up the question of drug interactions, given the wide choice of therapies now available combined with increasing numbers of comorbidities and medications used to treat those diseases. Dr. Saif gives several examples of both commonly prescribed medications and over the counter remedies that need careful consideration while personalizing treatments.
Dr. Saif’s statement that, “we don’t treat cancer, we treat cancer patients” reminds us that keeping patient, their goals, and their comfort in mind are paramount when personalizing treatment in patients with mCRC.
To get an in-depth understanding, view “Personalizing Treatment: A Strategy to Improve Outcomes for Patients with mCRC,” an online CME video offered by OMEDLIVE.
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