Common chemotherapy and targeted therapy options
Fortunately, therapy options for initial treatment of stage IV colorectal cancer or for earlier stage cancer that has spread (recurred or recurrent disease) have increased significantly in just the past few years.
New treatments have dramatically increased the percentages of patients responding to treatment, survival time, and the possibility that tumors of various stages can be removed surgically and cured.
At a glance, here are the 3 common types of chemotherapy regimens you may encounter, all of which are common drug combinations used in colorectal cancer today. These combinations are composed of FDA-approved medicines, each individually approved for treating CRC.
5-FU, Irinotecan (Camptosar®), and Leucovorin
These regimens may be combined with targeted therapies such as bevacizumab (Avastin®), cetuximab (Erbitux®), or panitumumab (Vectibix®).
Studies have found that patients with the best survival time are exposed to these three active chemotherapy agents — 5FU, or capecitabine (Xeloda®), oxaliplatin (Eloxatin®) and irinotecan (Camptosar®) during the total course of their treatment.
The right treatment depends on an individual’s overall health, potential side effects, and the specific goals of treatment.
A randomized clinical trial has shown that the sequence of drug combinations — FOLFOX followed by FOLFIRI or vice versa — makes no difference in overall survival. Choice of the initial agent can be based on side effect profile or patient preference.
Related chemotherapy options
Patients who are not able to tolerate intensive therapy have other options. Doctors may recommend:
- 5-FU plus leucovorin with or without bevacizumab (Avastin®). Continuous infusion 5-FU is more effective has fewer side effects than bolus 5-FU.
- Capecitabine (Xeloda®) with or without bevacizumab (Avastin®). Treatment with capectiabine (Xeloda®) alone should only be considered a reasonable option for selected patients who are not candidates for more aggressive combination regimens with oxaliplatin (Eloxatin®) or irinotecan (Camptosar®).
CHEMOTHERAPY OPTION TREATMENT PLAN WHEN STARTING TREATMENT WITH A COMBINATION THERAPY INCLUDING OXALIPLATIN (ELOXATIN®)
- FOLFOX with or without bevacizumab (Avastin®)
- CAPOX with or without bevacizumab (Avastin®)
- FOLFOX with or without panitumumab (Vectibix®)/Wild type gene only
Options if your cancer continues to grow or spread
- FOLFIRI with or without bevacizumab (Avastin®) or ziv-aflibercept (Zaltrap®)
- Irinotecan with or without bevacizumab (Avastin®) or ziv-aflibercept (Zaltrap®)
- FOLFIRI or irinotecan (Camptosar®) alone, plus cetuximab (Erbitux®) or panitumumab (Vectibix®)/KRAS Wild type gene only
Options after the above options have been tried, and your cancer continues to grow or spread
- Irinotecan (Camptosar®) with cetuximab (Erbitux®) or panitumumab (Vectibix®)/KRAS Wild type gene only
- For patients not able to tolerate combination therapy, consider cetuximab (Erbitux®) alone or panitumumab (Vectibix®) alone/KRAS Wild type gene only
- Regorafenib (Stivarga®)
- Clinical Trial
- Best Supportive Care
Options after the above options have been tried, and your cancer continues to grow or spread
- If not given previously, regorafenib (Stivarga®)
- Clinical Trial
- Best supportive Care
TREATMENT OPTIONS WHEN STARTING TREATMENT WITH A COMBINATION THERAPY INCLUDING IRINOTECAN (CAMPTOSAR®)
- FOLFIRI with or without bevacizumab (Avastin®)
- FOLFIRI with or without cetuximab (Erbitux®) or panitumumab (Vectibix®)/KRAS Wild type gene only
Options if your cancer continues to grow or spread
- FOLFOX with or without bevacizumab (Avastin®)
- CAPOX with or without bevacizumab (Avastin®)
- Irinotecan (Camptosar®) plus cetuximab (Erbitux®) or Panitumumab (Vectibix®)/KRAS Wild type gene only
- For patients not able to tolerate combination therapy, consider cetuximab (Erbitux®) alone or panitumumab (Vectibix®) alone/KRAS Wild type gene only
Options after the above options have been tried, and your cancer continues to grow or spread
- If not previously given, irinotecan (Camptosar®) with cetuximab (Erbitux®) or panitumumab (Vectibix®)/KRAS Wild type gene only
- For patients not able to tolerate combination therapy, consider cetuximab (Erbitux®) alone or panitumumab (Vectibix®) alone/KRAS Wild type gene only
- Regorafenib (Stivarga®)
- FOLFOX alone
- CAPOX alone
LATER TREATMENT OPTIONS
Options after the above options have been tried, and your cancer continues to grow or spread
- Regorafenib (Stivarga®) – if not previously prescribed
- Clinical Trial
- Best Supportive Care
Guidelines according to the National Comprehensive Cancer Networks Clinical Practice Guidelines in Oncology
Version 3.2013
Medically reviewed 3/5/2013
Dr. Neal Meropol
University Hospitals Case Medical Center & Case Western Reserve University
