Biologics A cytotoxic regimen in mCRC patients in first-line settings can be complemented by anti-EGFR or anti-VEGF drugs. When combined with the mainstay cytotoxic doublet or triplet regimen, or as monotherapies in specific cases, biologics addressing the tumoral receptor EGFR (cetuximab and panitumumab) or the angiogenic factor VEGF (bevacizumab, ramucirumab, aflibercept) have demonstrated improved outcomes. Second-line treatments The cytotoxic therapy backbone of choice in second-line treatment depends mainly on the treatment received in first-line. With first-line oxaliplatin-based therapy, guidelines recommend second-line treatment with irinotecan with fluoropyrimidine or monotherapy. Conversely, those treated with a first-line based on irinotecan will often receive oxaliplatin-based treatment (FOLFOX or CAPOX) in second-line if no contraindications exist. Third- and further-line treatment In patients eligible for a third- or further-line of systemic cytotoxic therapy, treatment strategies consist of reintroducing the initial induction therapy if no progress was seen during the firstline chemotherapeutic regime. Regorafenib and trifluridine-tipiracil (TAS-102) are recommended in patients pre-treated with fluoropyrimidines, oxaliplatin, irinotecan and biologics, if available, or in earlier lines of therapy following oxaliplatin and irinotecan regimen failure, depending on local approvals. 1 Jensen et al.: Journal of Experimental & Clinical Cancer Research (2023) 42:115, 2 Flaherty KT et al.: J Clin Oncol. 2020;38:3883–94, 3 Cervantes A et al.: ESMO Guidelines Committee 2023. DOI: https://doi.org/10.1016/j.annonc.2022.10.003 The current standard of care is devoid of biomarkers to inform therapeutic choices among the main cytotoxic drug compounds.
RkJQdWJsaXNoZXIy ODY1MjQ=