TARGET PATIENTS
The target for the IndiTreat® mCRC Explore test is patients with metastatic colorectal cancer showing tumor progression after at least two previous lines of drug therapy. The aim of treatment is palliative, with the intention to extend survival and/or improve quality of life
TREATMENT OPTIONS
When a patient shows disease progression after having received second line therapy, one treatment option is to “re-challenge” with oxaliplatin- or irinotecan-based regimens used in first line. Another option is treatment with drugs recommended as third line in international guidelines. These are the multi-targeted kinase inhibitor
regorafenib or an oral agent that combines trifluridine and tipiracil. A third option is to explore if the patient benefits from treatment with approved but off-label drug regimens in colorectal cancer such as mitomycin C plus fluorouracil, gemcitabine plus fluorouracil or temozolomide plus irinotecan.
TREATMENT OUTCOME
In general, overall survival in mCRC beyond second line is low -around 5 months with Standard of Care- and the improvement with the off-label use of drugs is modest.
| DRUG REGIMEN | MEDIAN OVERALL SURVIVAL | SOURCE |
|---|---|---|
| Regorafenib | 6.5 months |
Grothey et al. Lancet 2013 Jan 26;381 (9863): 303-12 |
| Trifluridine + Tipiracil | 7.1 months |
Grothey et al. Lancet 2013 Mayer et al. N Engl J Med 2015 May 14, 372 (20): 1909-19 |
| Mitomycin C + Capecitabine | 7.5 months |
Petrelli et al. Anticancer Drugs 2016 Jul; 27(6) :488-95 |
| Gemcitabine + Capecitabine | 6.5 months |
Jiménez-Fonseca et al. Clin Transl Oncol 2015 May; 17(5): 416-7 |
| Temozolomide + Irinotecan | *13.8 months |
Morano et al. Ann Oncol 2018 Aug 1; 29(8): 1800-1806 |
*in irinotecan-sensitive tumors bearing MGMT methylation
VALUE OF GUIDED TREATMENT
The unique value of the IndiTreat® test is that the individual patient response is predicted based on tumoroids created from the patient’s own tumor cells. This is important for clinical practice, as patients not likely to respond to treatment can be spared a therapy with troublesome adverse effects. Conversely, patients likely to respond can benefit from a longer Overall Survival than the average one reported in clinical trials.
| IndiTreat® mCRC Explore – DRUG PANEL | |
|---|---|
| Ordering Code: 2CX-01-CRC-03 | |
| Trifluridine + tipiracil | Mitomycin + 5FU |
| Regorafenib | Temozolamide + irinotecan |
| Gemcitabine + 5FU | |
