Colorectal cancer medical therapy: Difference between revisions
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*Regorafenib (Stivarga) - a kinase inhibitor | *Regorafenib (Stivarga) - a kinase inhibitor | ||
=====In clinical trials for treated/untreated metastatic disease | =====In clinical trials for treated/untreated metastatic disease[http://saci.uthscsa.edu/ClinicalTrials/SelectedPhase1.html#PhINovel]===== | ||
*[[Bortezomib]] (Velcade) | *[[Bortezomib]] (Velcade) | ||
*[[Oblimersen]] (Genasense, G3139) | *[[Oblimersen]] (Genasense, G3139) | ||
Revision as of 19:28, 15 July 2015
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Colorectal cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Colorectal cancer medical therapy On the Web |
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American Roentgen Ray Society Images of Colorectal cancer medical therapy |
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Risk calculators and risk factors for Colorectal cancer medical therapy |
To view the medical therapy of familial adenomatous polyposis (FAP), click here
To view the medical therapy of hereditary nonpolyposis colorectal cancer (HNPCC), click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Elliot B. Tapper, M.D., Saarah T. Alkhairy, M.D.
Overview
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, and slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy if surgery is not indicated (palliative). Other therapies include radiation and support therapies.
Medical Therapy
The following table indicates which treatment should be performed for each stage of colorectal carcinoma.
| Stage | Treatment |
| 0 (Carcinoma in situ) | Local excision or simple polypectomy; resection and anastomosis when the tumor is too large to remove by local excision |
| 1 | Resection and anastomosis |
| 2 | Resection and anastomosis which may be followed by chemotherapy |
| 3 | Resection and anastomosis which may be followed by chemotherapy; clinical trials of new chemotherapy regimens after surgery |
| 4 (and recurrent colon cancer) | Local excision for tumors that have recurred; resection with or without anastomosis; surgery to remove parts of other organs where the cancer may have recurred or spread (chemotherapy can be given to shrink the tumor, readiofrequency ablation or cryosurgery for patients who cannnot have surgery, chemoembolization of the hepatic artery); radiation therapy or chemotherapy may be offered as palliative therapy, chemotherapy and/or targeted therapy with a monoclonal antibody or an angiogenesis inhibitor; clinical trials of chemotherapy and/or targeted therapy |
Chemotherapy
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, and slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy if surgery is not indicated (palliative). The treatments listed here have been shown in clinical trials to improve survival and/or reduce mortality rate and have been approved for use by the US Food and Drug Administration.
Stage 2
The main options for adjuvant chemotherapy for this stage include 5-FU and leucovorin (alone) or capecitabine, but other combinations may also be used
Stage 3
The main options for adjuvant chemotherapy for this stage are FOLFOX (5-FU, leucovorin, and oxaliplatin) or CapeOx (capecitabine and oxaliplatin) regimens are used most often, but some patients may get 5-FU with leucovorin or capecitabine alone based on their age and health needs
Stage 4
Most patients with stage IV cancer will get chemotherapy. The most commonly used regimens include the following:
- FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
- FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
- CapeOX: capecitabine (Xeloda) and oxaliplatin (Eloxatin)
- Any of the above combinations plus either bevacizumab (Avastin) or cetuximab (Erbitux) (but not both)
- 5-FU and leucovorin, with or without bevacizumab
- Capecitabine, with or without bevacizumab
- FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
Irinotecan, with or without cetuximab
- Cetuximab (Erbitux) alone
- Panitumumab (Vectibix) alone
- Regorafenib (Stivarga) alone
Targeted therapy
VEGF targeted drugs These drugs are given by IV infusion every 2 or 3 weeks. Side effects include high blood pressure, fatigue, bleeding, leukopenia, headaches, mouth sores, loss of appetite, and diarrhea
- Bevacizumab (Avastin)
- Ramucirumab (Cyramza)
- Ziv-aflibercept (Zaltrap)
- Bevacizumab and ramucirumab are monoclonal antibodies and are typically combined with chemotherapy to treat advanced colon cancer
EGFR targeted drugs These drugs are given by IV infusion, either once a week or every other week. Side effects include an acne-like rash on the face and chest during treatment, headaches, fatigue, fever, and diarrhea
- Cetuximab is used in metastatic colorectal cancer, either as part of first-line treatment or after other treatments have been tried. Most often it is used either with irinotecan or by itself in those who can't take irinotecan or whose cancer is no longer responding to it.
- Panitumumab is used to treat metastatic colorectal cancer, usually after other treatments have been tried.
Other target drugs This drug is given in pill form. Side effects include fatigue, decreased appetite, hand-foot syndrome, diarrhea, sores in the mouth and throat, weight loss, voice change, infections, and high blood pressure. Some serious side effects that can occur include liver damage, severe bleeding, and perforations in the stomach or intestines.
- Regorafenib (Stivarga) - a kinase inhibitor
In clinical trials for treated/untreated metastatic disease[2]
- Bortezomib (Velcade)
- Oblimersen (Genasense, G3139)
- Gefitinib and Erlotinib (Tarceva)
- Topotecan (Hycamtin)
Radiation therapy
Radiotherapy is not used routinely in colon cancer since it could lead to radiation enteritis. It is also difficult to target specific portions of the colon. It is more commonly performed in rectal cancer since the rectum does not move as much as the colon and is easier to target.
Indications include:
- Colon cancer
- Pain relief and palliation
- Targeted at metastatic tumor deposits if they compress vital structures and/or cause pain
- Rectal cancer
- Neoadjuvant - given before surgery in patients with tumors that extend outside the rectum or have spread to regional lymph nodes in order to decrease the risk of recurrence following surgery or to allow for less invasive surgical approaches
- Adjuvant - where a tumor perforates the rectum or involves regional lymph nodes (AJCC T3 or T4 tumors or Duke's B or C tumors)
- Palliative - to decrease the tumor burden in order to relieve or prevent symptoms
Sometimes chemotherapy agents are used to increase the effectiveness of radiation by sensitizing tumor cells if present.
Support therapies
Cancer diagnosis very often results in an enormous change in the patient's psychological well-being. Various support resources are available from hospitals and other agencies which provide counseling, social service support, cancer support groups, and other services. These services help to mitigate some of the difficulties of integrating a patient's medical complications into other parts of their life.