Charles Fuchs, MD: First-Line Treatments in Unresectable Colon Cancer

What are the first-line treatments for patients diagnosed with advanced, unresectable colon cancer?

For a newly-diagnosed patient with metastatic colorectal caner, there are several options. Firstly, with regard to the chemotherapy backbone, one could either consider FOLFOX, namely an oxaliplatin-based regimen, or FOLFIRI, an irinotican-based regimen. What we know from the literature is that those two chemotherapy combinations have equivalent efficacy. They have some differences in toxicities, but both relatively well-tolerated and perfectly reasonable frontline regimens.

My own preference has historically been to start with FOLFOX, but I think FOLFIRI is an excellent regimen. With regard to the biologics that should be added to these regimens, and I think there's compelling evidence to add a biologic, bevacizumab is a very appropriate addition. That is the drugs that target the EGFR pathway have considering efficacy and there are several now approved. The combination of FOLFOX or FOLFIRI and bevacizumab is reasonable.

Unresectable Colon Cancer: Case 1

68-year-old man was diagnosed with advanced, unresectable colon cancer has just started treatment with FOLFIRI plus bevacizumab.