75 yo with slow progression 1 y after FOLFOX/bev -> 5-FU/bev?
What systemic treatment would you most likely recommend for the following patients:
A 75-year-old patient with asymptomatic 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?
Barni S et al. Cetuximab/irinotecan-chemotherapy in KRAS wild-type pretreated metastatic colorectal cancer: A pooled analysis and review of literature. Rev Recent Clin Trials 2013;[Epub ahead of print]. Abstract
Bennouna J et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): A randomised phase 3 trial. Lancet Oncol 2013;14(1):29-37. Abstract
Mitchell EP et al. The efficacy and safety of panitumumab administered concomitantly with FOLFIRI or irinotecan in second-line therapy for metastatic colorectal cancer: The secondary analysis from STEPP (Skin Toxicity Evaluation Protocol with Panitumumab) by KRAS status. Clin Colorectal Cancer 2011;10(4):333-9. Abstract
Peeters M et al. Mutant KRAS codon 12 and 13 alleles in patients with metastatic colorectal cancer: Assessment as prognostic and predictive biomarkers of response to panitumumab. J Clin Oncol 2013;31(6):759-65. Abstract
Ruff P et al. Analysis of overall survival and safety during the course of the phase III VELOUR trial comparing FOLFIRI and ziv-aflibercept or placebo in mCRC patients who progressed on prior oxaliplatin treatment. Proc ASCO 2013;Abstract 3574.