Tel: (202) 444-0275 Fax: (202) - - PowerPoint PPT Presentation

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Tel: (202) 444-0275 Fax: (202) - - PowerPoint PPT Presentation

Oct 31, 2022 127 likes •340 views

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  • Tel: (202) 444-0275

Fax: (202) 444-1229 http://lombardi.georgetown.edu/GI

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  • Chemo + Cetuximab

OS = 29.9 mos PFS = 10.4 mos Chemo + Bevacizumab OS = 29.0 mos PFS = 10.8 mos

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  • Side

N (Events)

Median (95% CI) HR (95% CI)

p

Left 732 (550) 33.3 (31.4-35.7) 1.60 (1.37-1.86) <0.001 Right 293 (242) 19.4 (16.7-23.6)

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  • Side

N (Events) Median (95% CI) HR (95% CI) p Left 376 (270) 36.0 (32.6-40.3) 1.99 (1.60-2.46) <0.001 Right 143 (121) 16.7 (13.1-19.4)

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RAS MSI BRAF PIK3CA PTEN RAS KRAS HER2/NEU APC TP53 RAS KRAS HER2/NEU APC TP53

2017 The Ruesch Center for the Cure of GI Cancers

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NCCN Nov 2016

  • “There is a preponderance of data to suggest

lack of activity of cetuximab and panitumumab in initial therapy of patients whose primary tumors originated on the right side of the colon”

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Basic Principles

Adjuvant Metastatic Strategy Curative Palliative Target Mesenchymal Cells Epithelial Cells Drugs 5FU/Capecitabine Oxaliplatin 5FU/Capecitabine Oxaliplatin Irinotecan VEGF EGFR TAS-102 Regorafanib Duration No more than 6 months Treat to progression Maintenance therapy

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“Facts” and Observations

  • FOLFOX did not have an “adjuvant” effect
  • FOLFIRINOX + Bevacizumab has the

highest RR

  • EGFR combo has high response and

resection rates but a negative trial

– Have to know RAS/BRAF

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Unknowns

  • Role of biologics
  • Duration of treatment pre- and post-op
  • Impact of systemic treatment in general
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