Skip to main content
Journal cover image

Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice.

Publication ,  Journal Article
Bekaii-Saab, T; Kim, R; Kim, TW; O'Connor, JM; Strickler, JH; Malka, D; Sartore-Bianchi, A; Bi, F; Yamaguchi, K; Yoshino, T; Prager, GW
Published in: Clin Colorectal Cancer
March 2019

An increasing number of patients with metastatic colorectal cancer (mCRC) are able to receive 3 or more lines of therapy. Treatments in this setting can include regorafenib (an oral multikinase inhibitor), trifluridine/tipiracil hydrochloride (TAS-102), antibodies that target epidermal growth factor receptor for patients with RAS wild-type tumors (if no prior exposure), and, where approved, anti-programmed cell death protein 1 inhibitors for patients with microsatellite instability-high mCRC. Although guidelines describe the available treatment options, few insights are provided to guide selection and sequencing. In this article, we share expert opinion from diverse geographic regions, to offer guidance for best practice when selecting and managing third-line treatment for mCRC. Various factors, including performance status, age, and tumor sidedness, can be used to guide treatment selection. Biomarkers, such as RAS, BRAF, and microsatellite instability, can be useful for treatment stratification. Management of adverse events, to maintain quality of life, is a key consideration and is crucial to best practice in this setting. Common toxicities associated with third-line treatments are hand-foot skin reaction, fatigue, diarrhea, and cytopenias. Patients who receive third-line and later-line treatments should be monitored for these events, especially during the first 2 cycles. Dose modifications can also be used to manage toxicities and to minimize the effect on quality of life, while maximizing treatment benefit. Clinical trials of emerging agents, new treatment combinations, and novel therapies continue the efforts to improve outcomes for patients with mCRC. Sharing expert opinions on best practice for treatment selection and management can ultimately improve outcomes for patients with mCRC.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Clin Colorectal Cancer

DOI

EISSN

1938-0674

Publication Date

March 2019

Volume

18

Issue

1

Start / End Page

e117 / e129

Location

United States

Related Subject Headings

  • Quality of Life
  • Practice Guidelines as Topic
  • Patient Selection
  • Oncology & Carcinogenesis
  • Neoplasm Metastasis
  • Microsatellite Instability
  • Humans
  • Dose-Response Relationship, Drug
  • Colorectal Neoplasms
  • Antineoplastic Combined Chemotherapy Protocols
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bekaii-Saab, T., Kim, R., Kim, T. W., O’Connor, J. M., Strickler, J. H., Malka, D., … Prager, G. W. (2019). Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice. Clin Colorectal Cancer, 18(1), e117–e129. https://doi.org/10.1016/j.clcc.2018.11.002
Bekaii-Saab, Tanios, Richard Kim, Tae Won Kim, Juan Manuel O’Connor, John H. Strickler, David Malka, Andrea Sartore-Bianchi, et al. “Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice.Clin Colorectal Cancer 18, no. 1 (March 2019): e117–29. https://doi.org/10.1016/j.clcc.2018.11.002.
Bekaii-Saab T, Kim R, Kim TW, O’Connor JM, Strickler JH, Malka D, et al. Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice. Clin Colorectal Cancer. 2019 Mar;18(1):e117–29.
Bekaii-Saab, Tanios, et al. “Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice.Clin Colorectal Cancer, vol. 18, no. 1, Mar. 2019, pp. e117–29. Pubmed, doi:10.1016/j.clcc.2018.11.002.
Bekaii-Saab T, Kim R, Kim TW, O’Connor JM, Strickler JH, Malka D, Sartore-Bianchi A, Bi F, Yamaguchi K, Yoshino T, Prager GW. Third- or Later-line Therapy for Metastatic Colorectal Cancer: Reviewing Best Practice. Clin Colorectal Cancer. 2019 Mar;18(1):e117–e129.
Journal cover image

Published In

Clin Colorectal Cancer

DOI

EISSN

1938-0674

Publication Date

March 2019

Volume

18

Issue

1

Start / End Page

e117 / e129

Location

United States

Related Subject Headings

  • Quality of Life
  • Practice Guidelines as Topic
  • Patient Selection
  • Oncology & Carcinogenesis
  • Neoplasm Metastasis
  • Microsatellite Instability
  • Humans
  • Dose-Response Relationship, Drug
  • Colorectal Neoplasms
  • Antineoplastic Combined Chemotherapy Protocols