colorectal cancer 2024 New treatment, New Hope

Recent advancement in the field of colorectal cancer therapy provides new hopes for patients with locally advanced colorectal cancer as well as metastatic disease.

[FarrahStarrable]

This is excellent presentation!! Thank you very much. I really appreciate it!

[jinniroe]

Thank you for a wonderful and information presentation!

[stanleykim]

The US Food and Drug Administration (FDA) has approved Lumakras (sotorasib) in combination with Vectibix (panitumumab) for the treatment of adults with metastatic colorectal cancer (CRC) who have KRAS G12C mutations, as determined by an FDA-approved test, and have received prior fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy.

The approval was based on data from the phase 3 CodeBreaK300 trial. The trial (NCT05198934) included 160 adults with KRAS G12C-mutant metastatic CRC who had received at least 1 prior line of therapy, including fluoropyrimidine, oxaliplatin, and irinotecan in the metastatic setting.

The patients were randomly assigned 1:1:1 to receive sotorasib at 960 mg daily plus panitumumab at 6 mg/kg every 2 weeks, sotorasib at 240 mg daily plus panitumumab at 6 mg/kg every 2 weeks, or investigator’s choice of standard of care (SOC) trifluridine/tipiracil or regorafenib.

The study’s primary endpoint was progression-free survival (PFS) by blinded independent central review. Panitumumab plus sotorasib at 960 mg improved PFS over SOC, but patients in the 240 mg sotorasib arm did not have an improvement in PFS over patients in the SOC arm. The median PFS was 5.6 months in patients who received panitumumab plus sotorasib at 960 mg and 2 months in the SOC arm (hazard ratio [HR], 0.48; 95% CI, 0.3-0.78; P =.005).

The overall response rate was 26% with panitumumab plus sotorasib at 960 mg (1 complete response and 13 partial responses) and 0% in the SOC arm. The median overall survival was not reached with panitumumab plus sotorasib at 960 mg and was 10.3 months with SOC (HR, 0.7; 95% CI, 0.41-1.18), a non-significant difference.

The most common adverse events reported with sotorasib at 960 mg in combination with panitumumab were rash, dry skin, diarrhea, stomatitis, fatigue, and musculoskeletal pain. The most common grade 3-4 laboratory abnormalities were decreased magnesium, decreased potassium, decreased corrected calcium, and increased potassium.

Lumakras is supplied in 120 mg, 240 mg, and 320 mg tablet strengths. The recommended dose of Lumakras for KRAS G12C-mutated metastatic CRC is 960 mg orally once daily in combination with panitumumab until disease progression or unacceptable toxicity. The first dose of Lumakras should be administered before the first panitumumab infusion.

In addition to this new indication, Lumakras is approved for use as a single agent to treat adults with advanced non-small cell lung cancer who have KRAS G12C mutations, as determined by an FDA-approved test, and have received at least 1 prior systemic therapy.

[stanleykim]

Corrections:
1. At 2:16, I said 5cm, but it should be 5 mm.
2. At 32:17, regarding intermittent therapy, I said some patients may take chemotherapy free time of several month or a year. But I should have said several months out of a year.

[ElabrarEbrahim]

thank you professor im going through oral exam you have saved me

[mohammedkhlid]

Thank you so much for your informative lectures our professor ❤.. I’m Egyptian Surgical oncologist, hope to find a lecture about sarcoma by your my preferred way in explanation .
Many thanks for helping us to understand and be updated our professor.❤

[stanleykim]

Adagrasib was approved by FDA for metastatic colorectal cancer with KRAS G12C mutation. It is combined with cetuximab with 35% responses rate:

[taytase]

Why no mention of Keytruda for right side colon cancer?

[stanleykim]

FDA approved Guardant Shield blood test for colorectal cancer screening. It provides 83% sensitivity.

[stanleykim]

OPRA trial update

The 3-year probability of OP (organ preservation: no surgery) was 77% (95% CI, 70%-85%) for patients with a CCR (clinical complete response) and 40% (95% CI, 32%-51%) for patients with an NCR (near complete response) (P < .001).

[stanleykim]

Who benefits adjuvant chemotherapy (ACT) in Stage 2 colon cancer?
The updated DYNAMIC trial showed that patients with (-)ctDNA do not need ACT.

[fatmaayman]

Where can i get pdf for this lecture??

[stanleykim]

FDA approved fam-trastuzumab deruxican (Enhertu) for any solid tumor with HER2 (+).

[Adriatiklota]

Pls help children whith colon cancer plz they are ding

[stanleykim]

FDA approved BRAF inhibitor for all solid cancer with BRAFV600E mutation.

[stanleykim]

FDA approved repotrektinib for metastatic solid tumor with NYRK fusion.

[coro]

교수님 림사랑에서 ebv관련글 잘 보았습니다 저희아이가 ebv로 t세프림프종과 hlh이 왔습니다 항암중 부작용이 심하게 와 옵디보(키트루다와같은기전으로알고있습니다)쓰려고 하고 있습니다 그런데 몇일전 스테로이드를 낮추는 과정에서 간수치가 7천까지 올라 간부전까지 올 수있는 위험한 상황이였어요 낮추면 열이 오른다거나 하는 순간은 많았습니다 다행히 고용량스테이로이로 위험한 순간은 넘겼지만 .. 신장투석으로 중환자실에 있습니다 옵디보를 몆일 안으로 사용하려 하는거 같은데 옵디보를 사용할 시 스테로이드를 끊어야 하는 상황에서 hlh이나 ebv가 얼마나 위험한 상황까지 갈 수도 있지 않을까 의료진들도 폭풍이 올거라고 무서운얘기만 했습니다 너무 두렵습니다 1회치료로 어느정도 효과가 있다면 너무 감사하겠지만 그러지 못하면 저번같은 간부전 상황까지 올까봐 너무 두렵습니다 11살딸아이입니다 혹시 의견들을수 있을까 유투브에 글남겨봅니다 간절한 마음으로 남겨봅니다