Join Barish Edil, MD, and Wells Messersmith, MD, as they present their multidisciplinary expertise on a range of cases pertaining to Metastatic Colorectal Cancer.

The management of metastatic colorectal cancer (mCRC) involves a continuum of care in which patients are exposed sequentially to a variety of active agents (5-FU/leucovorin, capecitabine, irinotecan, oxaliplatin, bevacizumab, ziv-aflibercept, cetuximab, panitumumab, regorafenib), either in combinations or as single agents. The choice of therapy is based on the goals of treatment (i.e., eradication of micrometastases in resectable patients, tumor shrinkage to obtain resectability, slowing of disease in unresectable patients), the type and timing of prior therapy, the different efficacy and toxicity profiles of the drugs, and the mutational status of the tumor. For the past several years, patients with tumor mutations in exon 2 of KRAS have not been offered panitumumab or cetuximab because tumors with such mutations are insensitive to these drugs.

In patients with mCRC, clinicians need to consider the goals of therapy (i.e., eradication of micrometastases in resectable patients, tumor shrinkage to obtain resectability, slowing of disease in unresectable patients), the different efficacy and toxicity profiles of the drugs, and patient preferences. Other considerations for the selection of therapy include the previous treatment history and, importantly, the tumor markers of the patient. Molecular testing has played an increasingly critical role for the determination of therapy.