Tanios Bekaii-Saab, MD: First-Line Treatments in Unresectable Colon Cancer

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

For patient who present for treatment in colorectal cancer, their first diagnosis with metastatic colon cancer, there are a number of options for those patients. It all depends whether the patients have a mutation in the RAS pathway or not. Assuming that this patient has no mutation in the RAS pathway, there are at least four different options — FOLFIRI bevacizumab, FOLFOX bevacizumab, FOLFIRI and one of the EGFR inhibitors like siltuximab or panitumumab, and FOLFOX with either siltuximab or panitumumab.

There are a number of options that would be available to those patients, and this is where you really start thinking about individualizing care with toxicities, efficacy, patient's preferences because some of these agents may lead to losing your hair and some patients prefer not to lose their hair, and these are the irinotecan-based regimens. EGFR inhibitors can cause a rash and some patients prefer, at least in the first-line, not to show their cancer. A rash is an indication of treatment, so they'd rather not be on EGFR inhibitors.

On the other hand, if a patient is a pianist or they use their hands and they need their fingers to have dexterity, they may be averse to neurotoxicity, which is mostly what you see with oxaliplatin. You have many options, which is good, and they all seem to be reasonably active and equivalent in many ways.

Unresectable Colon Cancer: Case 1

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