What systemic treatment would you most likely recommend for the following patients:
A 60-year-old patient with asymptomatic metastatic colorectal cancer (mCRC) responds to FOLFOX/bevacizumab but develops peripheral neuropathy. Oxaliplatin is stopped and the patient continues on 5-FU/bevacizumab with good treatment tolerance but after 1 year develops slow, minimally symptomatic disease progression on imaging and the peripheral neuropathy has still not resolved. The tumor is KRAS wild type.
Same patient as above, but the tumor is KRAS mutant?
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Kubicka S et al. Bevacizumab plus chemotherapy continued beyond first progression in patients with metastatic colorectal cancer previously treated with bevacizumab plus chemotherapy: ML18147 study KRAS subgroup findings. Ann Oncol 2013;24(9):2342-9. Abstract
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Sobrero AF et al. EPIC: Phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol 2008;26(14):2311-9. Abstract
Van Cutsem E et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol 2012;30(28):3499-506. Abstract