Dr Francis Daniel, MB. ChB, FFR-RCSI, FRCR. Consultant in Clinical Oncology

Dr Francis Daniel, MB. ChB, FFR-RCSI, FRCR.

Consultant in Clinical Oncology

www.bowelcancerwest.org.uk


What is new in Colorectal What is new in Colorectal Cancer Oncology?Cancer Oncology?


Local disease: Colon, Adjuvant Local disease: Colon, Adjuvant treatment.treatment.

Local disease: Rectum, Pre-op RT.Local disease: Rectum, Pre-op RT. Metastatic disease: New Metastatic disease: New

combinations, New agents.combinations, New agents. Cancer Drug Fund.Cancer Drug Fund.


Adjuvant Treatment Adjuvant Treatment (Colon&Rectum)(Colon&Rectum)

Flurouracil: 5-10 %Flurouracil: 5-10 % Capecitabine: 5-10%Capecitabine: 5-10% Combination Chemotherapy Combination Chemotherapy

(Oxaliplatin+Capecitabine): 15-20%(Oxaliplatin+Capecitabine): 15-20%


Pre operative RT for Rectal tumourPre operative RT for Rectal tumour

Selection is now refined (MRI Selection is now refined (MRI selective criteria)selective criteria)

Short Course RTShort Course RT (Mainly for low (Mainly for low rectum requiring APR)rectum requiring APR)

Long course RTLong course RT with chemo (Down with chemo (Down staging when margin is threatened)staging when margin is threatened)


Before AfterBefore After


Oxaliplatin + Capecitabine = 40% Oxaliplatin + Capecitabine = 40% Response rate.Response rate.

Irinotecan and Capecitabine = 40%Irinotecan and Capecitabine = 40% Cetuximab added = extra 10%Cetuximab added = extra 10% Bevacizumab added = extra 10%Bevacizumab added = extra 10%

Combination Chemotherapy for Combination Chemotherapy for advanced diseasesadvanced diseases


Cancer Drug FundsCancer Drug Funds

Bevacizumab and CetuximabBevacizumab and Cetuximab


Vascular Epidermal Growth Vascular Epidermal Growth ReceptorReceptor

VEGFR1 and VEGFR2 are expressed VEGFR1 and VEGFR2 are expressed on the surface of blood endothelial on the surface of blood endothelial cells. There is evidence that VEGFR2 cells. There is evidence that VEGFR2 is the major mediator of endothelial is the major mediator of endothelial cell mitogenesis, survival and cell mitogenesis, survival and microvascular permeability. microvascular permeability. Bevacizumab block this receptorsBevacizumab block this receptors


BevacizumabBevacizumab


The epidermal growth factor receptor The epidermal growth factor receptor (EGFR) is one of the members of the (EGFR) is one of the members of the family of receptor tyrosine kinases, which family of receptor tyrosine kinases, which consist of an extracellular domain that can consist of an extracellular domain that can bind ligands, a transmembrane domain bind ligands, a transmembrane domain and an intracellular tyrosine kinase and an intracellular tyrosine kinase domain. Cetuximab blocks binding of domain. Cetuximab blocks binding of ligands to EGFR, thereby inhibiting ligands to EGFR, thereby inhibiting receptor phosphorylation and downstream receptor phosphorylation and downstream events.events.

Epidermal Growth Factor ReceptorEpidermal Growth Factor Receptor


CetuximabCetuximab


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Dr Francis Daniel, MB. ChB, FFR-RCSI, FRCR. Consultant in Clinical Oncology

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