Promising Colorectal Cancer Treatments

What Is Colorectal Cancer?

Before reviewing that trial’s design and findings, let’s set the stage by quickly discussing what CRC is. Not including skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, the American Cancer Society reports. Colon and rectal cancers often are grouped together because they share many similarities.

Colorectal cancer starts when abnormal growths, called polyps, form in the colon or rectum. Over time, these growths can turn cancerous without warning signs or symptoms. That is why patients should receive regular colon cancer screenings.

About the Study

The clinical trial, called SUNLIGHT, was headed by Josep Tabernero, MD, PhD, of the Vall d’Hebron University Hospital in Barcelona, Spain. The study included nearly 500 participants with advanced colorectal cancers whose condition worsened after undergoing at least two treatment regimens. Prior treatments included:

• One or more chemotherapy agents – including fluoropyrimidine, irinotecan (Camptosar^®), or oxaliplatin (Eloxatin^®); or
• Bevacizumab (Avastin^®), a targeted therapy.

The study evaluated the efficacy and safety of trifluridine and tipiracil (Lonsurf^®) in combination with bevacizumab. The FDA previously had approved these agents separately for treating colorectal cancer.

The open-label, controlled, two-arm, phase 3 study assigned participants at random to receive trifluridine and tipiracil alone or combined with bevacizumab.

Study Findings

The study found that using the two therapies together benefitted patients with previously treated metastatic colorectal cancer. After a median follow-up of 14 months, participants who received the combination therapy survived for a median of 10.8 months, compared with a median of 7.5 months among patients who received trifluridine–tipiracil alone.

The two-therapy regimen also lengthened progression-free survival by several months (a median of 5.6 months versus 2.4 months with the single therapy).

Participants in both groups reported side effects. The most common side effects included:

• Neutropenia, an abnormally low level of neutrophils, a type of white blood cell that plays a key role in the body’s immune response to bacteria and viruses
• Nausea
• Anemia (a low red blood cell count)

The combination-therapy group reported more cases of neutropenia and hypertension (high blood pressure) than the single-therapy group. The study’s investigators noted that the combination group experienced additional side effects compared with the single-treatment group, but that most patients tolerated those side effects reasonably well.

On the strength of these findings, in August 2023 the FDA approved use of trifluridine-tipiracil in combination with bevacizumab for the treatment of metastatic colorectal cancer after the above-mentioned chemotherapies or certain biologic agents have failed.

Though the survival gains in SUNLIGHT were modest, they represent further progress toward the goal of making later-stage cancers more treatable. In many, many types of cancer, patients with advanced disease are living far longer than they would have just 5 or 10 years ago, and often are doing so with a very good quality of life.  Studies such as SUNLIGHT are key to continued progress in preserving both life and quality of life.

Colorectal Cancer Treatments at RCCA

Drug therapies such as the combination regimen evaluated in the SUNLIGHT study and then approved by the FDA represent just one facet of physicians’ comprehensive approach to treating colorectal cancer. Other interventions, such as surgery and radiation therapy, also play a key role, and a person with colorectal cancer may well be treated with, for example, surgery followed by chemotherapy, or other sequences or combinations of treatment modalities. Options for treating CRC include:

Surgery

Surgery is often the first and main form of treatment for early-stage colorectal cancers. The location, type, and stage of cancer determines the type of surgery performed.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells and prevent their spread. Radiation therapy often is combined with other types of treatment.

Chemotherapy

Chemotherapy uses powerful medications to attack and kill cancer cells or prevent them from spreading. By reducing the size of tumors, these drugs may also alleviate pain and other symptoms. Chemotherapy may be administered orally or intravenously.

Targeted Therapy

Like chemotherapy, targeted therapy uses drugs to attack cancer cells or disrupt their function and reproduction. However, these medications specifically affect malignant cells – typically by binding to receptors on their surface — while leaving healthy cells intact.

Immunotherapy

Immunotherapy enhances the body’s immune system, empowering it to recognize and destroy cancer cells.

Colorectal Cancer Care from a Trusted Provider

If you’ve been diagnosed with colorectal cancer or need a second opinion, the dedicated treatment team at RCCA is here to help. Our experienced medical oncologists and hematologists offer compassionate, comprehensive care and cutting-edge, evidence-based treatment.

RCCA has 22 community-based, conveniently located treatment centers throughout New Jersey, Connecticut, Maryland, and the Washington, DC area. To learn more or to arrange an appointment, contact RCCA today.