New treatments offer better survival and fresh challenges in colorec...(ly linked to the number of active drugs ...),Health

Date:8/21/2009

ly linked to the number of active drugs available to treat this disease," says Grothey. However, he adds that this treatment abundance also provides oncologists with specific challenges for managing palliative medical therapy in advanced CRC, particularly when they use targeted agents.

One targeted agent is bevacizumab (a monoclonal antibody developed by Genentech under the trade name Avastin), which inhibits vascular endothelial growth factor (VEGF), a natural protein that the tumour uses to grow new blood vessels (angiogenesis). Bevacizumab was the first angiogenesis inhibitor available in the US, and has become established as a standard component of first-line chemotherapy.

To date, no researchers have identified a predictive marker for bevacizumab's activity in metastatic CRC. According to Grothey, key questions surrounding bevacizumab's use in the palliative setting are whether it provides clinical benefit beyond the stage of tumour progression, and which patient group is at higher risk for bevacizumab-related toxicities. Data from a large observational, non-randomised cohort study by Grothey and colleagues in 2008 suggests that patients may benefit from continued use of bevacizumab beyond tumour progression . Randomised phase III clinical trials are currently underway in Europe and the US to determine whether this should become standard practice.

Anti-epidermal growth factor receptor (EGFR) antibodies cetuximab (Erbitux) and panitumumab (Vectibix) are both targeted monoclonal antibody treatments that have demonstrated efficacy both in combination with chemotherapy or, in contrast to bevacizumab, used alone. Trials on unselected patient groups show limited results. But clinical trials and translational studies now indicate that those patients with advanced CRC must have a tumour with specific genetic mutations (wild type KRAS and wild-type BRAF) for EGFR antibodies to be effective. Testing for BRAF and KRAS mutations now excludes ab
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Contact: Mithu Mukherjee mithu.mukherjee@sagepub.co.uk 44-207-324-2223 SAGE Publications UK Source:Eurekalert

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