How Do We Make Choices in Salvage Therapy: Panitumumab, Cetuximab, or Regorafenib?
Colorectal cancer is the fourth commonest cancer worldwide. The survival rate is suboptimal for patients with metastatic disease. The introduction of anti-epidermal growth factor receptor (EGFR) antibodies has remarkably improved clinical outcomes. Two monoclonal antibodies targeting EGFR and one multikinase inhibitor have been approved by the FDA and Health Canada for the treatment of metastatic colorectal cancer; however, only about 10 % of patients respond to this treatment. Having wild-type KRAS is necessary but not sufficient to derive benefit from EGFR inhibition. Interestingly, patients with certain mutations such as p.G13D represent a cetuximab-sensitive subtype of KRAS mutant metastatic colorectal cancer. A few biomarkers have been identified, but we still do not know the best way to administer drugs. In this article we review the clinical data and expert opinions and summarize the recommendations.