Colorectal Cancer


Currently 5 biological treatments are licensed for use in patients with bowel cancer which has spread elsewhere


Bevacizumab  (also known as Avastin ) – is an antibody to the Vascular Endothelial Growth Factor which has a role in a variety of malignancies. In colorectal cancer, combined with conventional chemotherapy, it has a clear role in both first and subsequent lines of treatment. It can be given every 2 or 3 weeks depending on the chemotherapy schedule being used.


Cetuximab (also known as Erbitux ) is an antibody to the Epidermal Growth Factor Receptor. Its main use is in the treatment of colorectal cancer but it also has a role in head & neck tumours. Importantly testing for mutations within the RAS genes can identify patients for whom Cetuximab may be helpful and such testing is now routine when this treatment is being considered. In suitable patients with colorectal cancer the use of cetuximab with chemotherapy in the first line setting provides significant advantage over and above that achieved with chemotherapy and it is also used in later lines either in combination with chemotherapy or on its own.


Panitumumab (also known as Vectibix ) is a drug with similarities to Cetuximab – because it is a humanised antibody, it appears to be associated with less allergic side-effects. Like cetuximab it has a well defined first-line role, it can also be used in later lines of therapy and testing for mutations within RAS can help identify those patients likely to benefit from this drug.


Aflibercept (also known as Zaltrap ) is a fusion protein which blocks a number of biological target receptors. Its main role is in the second-line setting where, when given in combination with irinotecan-based chemotherapy, it ca provide additional advantage.


Regorafenib (also known as Stivarga ) is a small-molecule inhibitor which works by blocking proteins within cancer cells that are involved in control of cancer cell (protein tyrosine kinases). It is taken in tablet form and can be considered in some patients when they may otherwise have exhausted all other treatment options.


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