文档介绍：Challenges in the treatment of mCRC
Dirk Arnold
Hubertus Wald Tumour Centre Hamburg, Germany
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Treatment paradigms for mCRC
Some patients with stage IV disease can be cured by an interdisciplinary team approach
Most patients can tolerate a chemotherapy doublet, but not all need it
FOLFOX = XELOX = FOLFIRI (= XELIRI)
The addition of biological agents has improved es
Increased understanding of biological markers may allow tailored treatment for some patients
Can es be improved further?
Patient treatment challenges Selecting the best option to maximise patient benefit
Choice of first-line treatment
Mono or doublet chemotherapy; oxaliplatin or bination; choice of biological?
First-line treatment strategy
Treatment duration; maintenance treatment; treatment holiday?
Treatment post-progression and in further lines of therapy
Change chemotherapy regimen; continue biological agent?
ESMO guidelines: first-line strategy for mCRC
Van Cutsem, et al. Ann Oncol 2010
Does the patient need (or desire) aggressive therapy?
Yes ~85%
KRAS status
No ~15%
5-FU/capecitabine ± bevacizumab
Unavailable
Wild-type
Mutant
Doublet + bevacizumab
Doublet + bevacizumab Doublet + cetuximab
Doublet + bevacizumab
?
?
Criteria for determining treatment intensity
Patient status
ECOG PS
co-morbidities
prior treatment
Tumour characteristics
resectability of metastases
rate of disease progression
importance of tumour shrinkage
Anticipated toxicity profile of treatment and patient preferences
Patient segments: suggestions from German S3 guidelines and ESMO mendations 2010
Arnold, Onkologie 2008; Van Cutsem, et al. Ann Oncol 2010
Clinical situation
What is needed?
Treatment intensity
Liver (lung) metastases
potentially resectable
Multiple metastases with
rapid progression
tumour-related symptoms
risk of rapid deteri