Third-line Therapy for Colon Cancer
Third-line Therapy for Colon Cancer
A 54-year-old woman with colon cancer and multiple unresectable liver metastases received 5-FU/LV and then irinotecan/UFT, but serial CT scans continue to show enlarging lesions. She is relatively asymptomatic and fully active. What would you recommend as third-line therapy?
The patient has multiple unresectable liver metastases and has received 5-FU/leucovorin and then an irinotecan-containing regimen. She now has progressed. The patient is asymptomatic and has an excellent performance status. There are 2 appropriate considerations for the management of the patient at this time.
The one I would favor would be the use of FOLFOX. FOLFOX (5-FU/leucovorin, and oxaliplatin) is active in patients who have had previous 5-FU/leucovorin and irinotecan, making this an appropriate strategy to manage the patient at this point.
Another option that has just recently become available is therapy with single-agent irinotecan and the anti-epidermal growth factor monoclonal antibody cetuximab. Data presented at ASCO 2003 demonstrated that approximately 22% of patients failing irinotecan will respond when cetuximab is added to the irinotecan regimen.
The ultimate goal in a patient like this one is to achieve continued regression of disease to the point where she will be able to undergo a liver-directed procedure, such as surgical resection or radiofrequency ablation. We do not generally use hepatic arterial infusion chemotherapy in patients who have liver-only disease but have had multiple previous courses of systemic chemotherapy. The response rates for hepatic arterial chemotherapy are not very favorable in this situation.
A 54-year-old woman with colon cancer and multiple unresectable liver metastases received 5-FU/LV and then irinotecan/UFT, but serial CT scans continue to show enlarging lesions. She is relatively asymptomatic and fully active. What would you recommend as third-line therapy?
The patient has multiple unresectable liver metastases and has received 5-FU/leucovorin and then an irinotecan-containing regimen. She now has progressed. The patient is asymptomatic and has an excellent performance status. There are 2 appropriate considerations for the management of the patient at this time.
The one I would favor would be the use of FOLFOX. FOLFOX (5-FU/leucovorin, and oxaliplatin) is active in patients who have had previous 5-FU/leucovorin and irinotecan, making this an appropriate strategy to manage the patient at this point.
Another option that has just recently become available is therapy with single-agent irinotecan and the anti-epidermal growth factor monoclonal antibody cetuximab. Data presented at ASCO 2003 demonstrated that approximately 22% of patients failing irinotecan will respond when cetuximab is added to the irinotecan regimen.
The ultimate goal in a patient like this one is to achieve continued regression of disease to the point where she will be able to undergo a liver-directed procedure, such as surgical resection or radiofrequency ablation. We do not generally use hepatic arterial infusion chemotherapy in patients who have liver-only disease but have had multiple previous courses of systemic chemotherapy. The response rates for hepatic arterial chemotherapy are not very favorable in this situation.
