Metastatic colorectal cancer (cancer that has spread from the colon or rectum, beyond the lymph nodes) can be cured about 10% of the time, thus is usually incurable with a median survival of less than 2-years with treatment, about 9-months without treatment and 5-year survival of 10%. (Holland Frei Cancer Medicine 6th edition). At PCR Oncology we do somewhat better than national averages with 33% 5-year survivals for metastatic colon cancer.

The options for treatment of metastatic colon cancer include:

1. Chemotherapy

a. 5-FU, leucovorin and oxaliplatin (FOLFOX)

b. 5-FU, leucovorin and irinotecan (FOLFIRI)

2. Targeted therapy

a. Cetuximab and panitumumab (antibodies aimed at the epidermal growth factor receptor)

b. Bevacizumab (antibody aimed at VEG-F, a hormone that stimulates growth of new blood vessels, thus preventing growth of new blood vessels)

3. Immunotherapy

Pembrolizumab – PDL1 antibody that exposes tumor cells to immune system and is FDA approved for “microsatellite unstable” colon cancer. This comprises about 15% of colon cancers.

The 85% of patients with metastatic colon cancers that are not candidates for immunotherapy and who choose to try treatments usually receive FOLFOX or FOLFIRI with a targeted treatment. I have patients with metastatic colon cancers that were controlled for 4 or more years with FOLFIRI. Unfortunately FOLFOX can generally not be used for more than 6-months because of nerve damage caused by oxaliplatin.

Neuroprotective agents may permit the use of FOLFOX without nerve damage, extending the use of this combination and allowing longer control of colon cancer.

PCR Oncology was the first practice in the United States to open a Phase III trial testing PledOx to prevent nerve damage from FOLFOX chemotherapy in combination with a targeted agent for initial treatment of metastatic (stage IV) colon cancer. We are one of only about 20 sites in the United States with this treatment and the only practice in central California.

Metastatic colon cancer is a frightening disease. PCR Oncology is committed to improving outcomes as evidenced by our first-in-country status opening an exciting new clinical trial. The basic eligibility criteria are: Good underlying health, diagnosis of metastatic colon cancer and no prior treatment for metastatic colon cancer.

Anyone interested in this trial may call (805-474-9143) and ask for additional information.

David Palchak MD