NP Offers Insights on CRC Updates, Treatment Options

As the treatment landscape for colorectal cancer (CRC) continues to change, there are key points that oncology nurses need to remember, according to Edith Brutcher, NP.

Brutcher, a nurse practitioner at the Emory Winship Cancer Institute and adjunct faculty at Emory Woodruff School of Nursing, discussed CRC updates at the 38^th Annual CFS Virtual, Interactive Conference.¹

“We’ve had such a rapid increase in what we can use now in the treatment of CRC,” Brutcher said. “Like me, you may remember when there was a time when there was just a few. And all of these advancements are really exciting.”

RAS Mutations and Cancer Sidedness

About half of CRC cases have a KRAS mutation or extended RAS mutation, while the other half is considered RAS wildtype. While mutational status could play a major role in determining a patient’s treatment, it is not the only factor to be considered, Brutcher said. The location of the cancer must be taken into account, too, especially when discussing potential outcomes with a patient.

Left-sided CRCs, which are more common, tend to have better response rates, while right-sided CRCs tend to have poor prognostic futures.

Additionally, left-sided CRC that is RAS wildtype has the best prognosis, while right-sided RAS wildtype disease has the worst prognosis.

“That’s why you may see in frontline therapy that left-sided, RAS wildtype could receive

an anti-EGFR antibody in the frontline therapy,” Brutcher said.

Treatment Duration

Another exciting development that Brutcher discussed was recent findings that showed that there was no statistically significant difference in outcomes between patients with stage II CRC who were given 3 months of adjuvant capecitabine (Xeloda) plus oxalipltin (Eloxatin) — a treatment known as CAPOX – compared to those who were given 6 months.²

“So we can treat patients with 3 months of CAPOX and then have the same outcome as if you would have treated it for 6 months, which is very exciting for most toxicities,” Brutcher said.

In that same study, which was published in JAMA Oncology, a 3-month regimen of FOLFOX (fluorouracil, leucovorin, and oxaliplatin) did prove to be noninferior to the 6-month regimen, though the shorter treatment duration was less toxic.

“The outcomes of this trial were very interesting, and helped us to make treatment decisions,” Brutcher said.

References

• Brutcher E. Advances in Colorectal Cancer Care: What Nurses Need to Know. Presented at: 38^th Annual CFS Virtual, Interactive Meeting. November 4-6, 2020
• Petrelli F, Labianca R, Zaniboni A, et. al. Assessment of Duration and Effects of 3 vs 6 months of adjuvant chemotherapy in high-risk stage II colorectal cancer. JAMA Oncol. 2020;6(4):547-551. doi:10.1001/jamaoncol.2019.6486