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Investigator Perspectives on the Current Utility of Validated and Emerging Biomarkers to Guide Treatment Decision-Making for Patients with Metastatic Colorectal Cancer: Personalized Selection of Systemic Therapy N = 26 Completed Surveys
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Co-Chairs Survey Participants Tanios Bekaii-Saab, MD Alan P Venook, MD
Professor Dirk Arnold, MD, PhD Heinz-Josef Lenz, MD Johanna Bendell, MD Christopher Lieu, MD Al B Benson III, MD John L Marshall, MD Jordan D Berlin, MD Wells A Messersmith, MD Kristen Ciombor, MD, MSCI Jeffrey A Meyerhardt, MD, MPH Steven J Cohen, MD Michael A Morse, MD, MHS Aimery de Gramont, MD Bert H O'Neil, MD Cathy Eng, MD Michael J Overman, MD Richard M Goldberg, MD Philip A Philip, MD, PhD J Randolph Hecht, MD Eric Van Cutsem, MD, PhD Howard S Hochster, MD Zev Wainberg, MD, MSc Scott Kopetz, MD, PhD Christina Wu, MD N = 26 investigators
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Indications for and Practical Implementation of Biomarker Analysis for Patients with Metastatic Colorectal Cancer (mCRC)
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In general, what type of tumor assays, if any, do you order for your patients with mCRC?
25 Pan-RAS (KRAS/NRAS) 25 BRAF 25 MSI status 24 HER2 PIK3CA 8 NGS panel 5 KRAS 2 NRAS 2 NTRK 1 N = 26 clinical investigators
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What type of tumor assays, if any, do you believe oncologists in community practice should be ordering for these individuals? 26 Pan-RAS (KRAS/NRAS) 26 MSI status 25 BRAF 17 HER2 KRAS 2 NRAS 2 PIK3CA 2 NTRK 2 BRCA 1 N = 26 clinical investigators
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Do you believe there is any current role for rebiopsy/repeat biomarker assessment in patients with progressive mCRC? Yes 16 No 10 N = 26 clinical investigators
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Biology of mCRC and Role of Tumor Sidedness in First- and Later-Line Decision-Making
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 9 FOLFOX/CAPOX + bevacizumab 5 FOLFOX/CAPOX + cetuximab 4 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + panitumumab 3 FOLFIRI/CAPIRI + cetuximab 2 FOLFIRI/CAPIRI + panitumumab 1 1 FOLFIRI/CAPIRI Capecitabine + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 5 FOLFOX/CAPOX + panitumumab 5 FOLFOXIRI + bevacizumab 4 FOLFOX/CAPOX + cetuximab 3 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + panitumumab 2 FOLFIRI/CAPIRI + cetuximab 2 FOLFOXIRI + panitumumab 1 FOLFOXIRI + cetuximab 1 FOLFIRINOX + cetuximab 1 FOLFOXIRI N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 18 FOLFOX/CAPOX + bevacizumab 5 FOLFIRI/CAPIRI + bevacizumab FOLFIRI/CAPIRI 1 Capecitabine + bevacizumab 1 N = 25 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type FOLFOXIRI + bevacizumab 13 6 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 3 FOLFOXIRI 1 FOLFIRINOX + bevacizumab 1 N = 24 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 10 FOLFOX/CAPOX + bevacizumab 5 Capecitabine + bevacizumab 3 FOLFOX/CAPOX + cetuximab FOLFOX/CAPOX 2 2 5-FU/LV + cetuximab 1 FOLFIRI/CAPIRI 1 FOLFIRI/CAPIRI + bevacizumab 1 FOLFIRI/CAPIRI + panitumumab 1 5-FU/LV + bevacizumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 9 FOLFOX/CAPOX + bevacizumab 5 FOLFOX/CAPOX + cetuximab 4 FOLFOX/CAPOX + panitumumab FOLFIRI/CAPIRI + bevacizumab 3 FOLFOX/CAPOX 2 FOLFIRI/CAPIRI + panitumumab 1 1 FOLFOXIRI FOLFIRI/CAPIRI + cetuximab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type FOLFOX/CAPOX + bevacizumab 14 5 Capecitabine + bevacizumab 5-FU/LV + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 2 FOLFOX/CAPOX 1 FOLFIRI/CAPIRI 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 19 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 4 FOLFOXIRI + bevacizumab 2 FOLFOX/CAPOX 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 11 FOLFIRI/CAPIRI + bevacizumab 5 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + panitumumab FOLFOX/CAPOX + panitumumab 2 Irinotecan + cetuximab 2 1 FOLFIRI/CAPIRI + panitumumab 1 FOLFOX/CAPOX 1 FOLFIRI/CAPIRI + cetuximab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 6 FOLFIRI/CAPIRI + panitumumab 5 FOLFIRI/CAPIRI + bevacizumab 4 Irinotecan + panitumumab 4 FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 2 FOLFIRI/CAPIRI + cetuximab 1 FOLFOX/CAPOX 1 FOLFOX/CAPOX + panitumumab 1 FOLFOXIRI + panitumumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 15 FOLFIRI/CAPIRI + bevacizumab 5 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + EGFR antibody 5-FU/LV + bevacizumab 1 FOLFOX/CAPOX 1 Irinotecan + cetuximab 1 1 Irinotecan + bevacizumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 13 FOLFIRI/CAPIRI + bevacizumab 3 Irinotecan + panitumumab 2 FOLFIRI/CAPIRI + panitumumab 2 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + cetuximab 1 5-FU/LV + bevacizumab 1 FOLFOXIRI + bevacizumab 1 Irinotecan + cetuximab 1 Panitumumab 1 FOLFIRI + aflibercept N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 9 FOLFIRI/CAPIRI + bevacizumab 4 Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + panitumumab 2 Irinotecan + bevacizumab FOLFIRI/CAPIRI + panitumumab 1 1 FOLFOX/CAPOX 1 FOLFOX/CAPOX + panitumumab 1 Panitumumab 1 FOLFIRI/CAPIRI + cetuximab N = 26 clinical investigators
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Symptom burden: Requires response Tumor location: Left side
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on your first-line treatment of the choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 8 FOLFIRI/CAPIRI + bevacizumab 4 Irinotecan + cetuximab 3 Irinotecan + panitumumab 2 FOLFOX/CAPOX 2 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + panitumumab 1 FOLFOX/CAPOX + panitumumab 1 FOLFIRI/CAPIRI + cetuximab 1 FOLFOXIRI + panitumumab 1 Panitumumab 1 FOLFIRI N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 12 FOLFIRI/CAPIRI + bevacizumab 5 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + bevacizumab Irinotecan + cetuximab 2 Irinotecan 2 FOLFOX/CAPOX 1 1 FOLFIRI/CAPIRI + panitumumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 15 FOLFIRI/CAPIRI + bevacizumab 4 FOLFOX/CAPOX + bevacizumab Irinotecan + cetuximab 2 FOLFOX/CAPOX 1 FOLFIRI/CAPIRI + panitumumab 1 FOLFIRI/CAPIRI + cetuximab 1 1 Irinotecan + panitumumab FOLFIRI 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 8 Regorafenib 7 TAS-102 5 Irinotecan + panitumumab Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 1 Panitumumab 1 1 Cetuximab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 8 TAS-102 5 Irinotecan + panitumumab 5 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 2 1 FOLFIRI/CAPIRI + panitumumab 1 Cetuximab N = 24 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 8 TAS-102 7 Regorafenib 5 Irinotecan + panitumumab Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 1 Panitumumab 1 N = 25 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 9 TAS-102 4 Irinotecan + panitumumab 4 Regorafenib Irinotecan + cetuximab 3 2 FOLFOX/CAPOX + bevacizumab 1 FOLFIRI/CAPIRI + panitumumab 1 Cetuximab N = 24 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 11 TAS-102 6 Regorafenib 4 Irinotecan + panitumumab Irinotecan + cetuximab 2 2 Panitumumab 1 FOLFOX/CAPOX + bevacizumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 9 TAS-102 5 Irinotecan + panitumumab 5 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 2 FOLFIRI/CAPIRI + panitumumab 1 1 Panitumumab Cetuximab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 11 TAS-102 5 Regorafenib 4 Irinotecan + panitumumab Irinotecan + cetuximab 3 2 Panitumumab 1 FOLFOX/CAPOX + bevacizumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 11 TAS-102 4 Regorafenib 4 Irinotecan + panitumumab Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + panitumumab 1 1 Panitumumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 19 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 5 FOLFIRI/CAPIRI 1 Capecitabine + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation 12 FOLFOXIRI + bevacizumab 9 FOLFOX/CAPOX + bevacizumab 2 FOLFOXIRI 2 FOLFIRI/CAPIRI + bevacizumab FOLFIRINOX + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 19 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 5 FOLFIRI/CAPIRI 1 Capecitabine + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Right Biomarker status: RAS mutation 13 FOLFOXIRI + bevacizumab 8 FOLFOX/CAPOX + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI 1 1 FOLFIRINOX + bevacizumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 12 FOLFOX/CAPOX + bevacizumab 5 Capecitabine + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 5-FU/LV + bevacizumab 3 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 1 FOLFIRI/CAPIRI N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation FOLFOX/CAPOX + bevacizumab 18 FOLFIRI/CAPIRI + bevacizumab 3 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 1 FOLFOXIRI FOLFOXIRI + bevacizumab 1 5-FU/LV + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 13 FOLFOX/CAPOX + bevacizumab 5 Capecitabine + bevacizumab 3 5-FU/LV + bevacizumab FOLFIRI/CAPIRI + bevacizumab 2 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 1 FOLFIRI/CAPIRI N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Right Biomarker status: RAS mutation FOLFOX/CAPOX + bevacizumab 18 4 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI + bevacizumab 2 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation FOLFIRI/CAPIRI + bevacizumab 17 4 FOLFOX/CAPOX + bevacizumab FOLFOX/CAPOX 2 Irinotecan + cetuximab 2 FOLFIRI + aflibercept 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation 15 FOLFIRI/CAPIRI + bevacizumab 3 FOLFOX/CAPOX + bevacizumab 3 TAS-102 2 FOLFIRI + aflibercept 1 FOLFOX/CAPOX 1 FOLFOXIRI + bevacizumab 1 Irinotecan + cetuximab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 17 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 4 1 5-FU/LV + bevacizumab FOLFOX/CAPOX 1 Irinotecan + cetuximab 1 Irinotecan + bevacizumab 1 1 FOLFIRI + aflibercept N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation 17 FOLFIRI/CAPIRI + bevacizumab 3 TAS-102 2 FOLFOX/CAPOX + bevacizumab 5-FU/LV + bevacizumab 1 FOLFOXIRI + bevacizumab 1 Irinotecan + cetuximab 1 1 FOLFIRI + aflibercept N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 15 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 4 2 FOLFOX/CAPOX Irinotecan 2 Irinotecan + bevacizumab 2 Irinotecan + cetuximab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation FOLFIRI/CAPIRI + bevacizumab 17 3 FOLFOX/CAPOX + bevacizumab FOLFOX/CAPOX 2 Irinotecan + cetuximab 1 Irinotecan 1 FOLFIRI 1 1 FOLFIRI + aflibercept N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 14 FOLFIRI/CAPIRI + bevacizumab 6 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + bevacizumab Irinotecan + cetuximab 1 Irinotecan 1 FOLFOX/CAPOX 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation 17 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 4 1 FOLFOX/CAPOX Irinotecan + cetuximab 1 Irinotecan 1 FOLFIRI 1 1 FOLFIRI + aflibercept N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 15 TAS-102 Regorafenib 9 1 Irinotecan + cetuximab N = 25 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation 13 TAS-102 8 Regorafenib 1 FOLFOX/CAPOX + bevacizumab Irinotecan + cetuximab 1 1 Irinotecan + panitumumab N = 24 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 15 TAS-102 9 Regorafenib 1 Irinotecan + cetuximab N = 25 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation 14 TAS-102 8 Regorafenib 1 FOLFOX/CAPOX + bevacizumab Irinotecan + cetuximab 1 N = 24 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation TAS-102 18 6 Regorafenib FOLFOX/CAPOX + bevacizumab 1 Irinotecan + cetuximab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation TAS-102 17 6 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation TAS-102 18 6 Regorafenib FOLFOX/CAPOX + bevacizumab 1 Irinotecan + cetuximab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation TAS-102 17 6 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 1 N = 26 clinical investigators
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Current and Future Treatment Options for Patients with BRAF Mutations
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOXIRI + bevacizumab 8 FOLFOX/CAPOX + bevacizumab 1 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI 1 Encorafenib + binimetinib + cetuximab 1 FOLFIRINOX + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Biomarker status: BRAF V600E mutation (RAS wild type) Tumor location: Left side 17 FOLFOXIRI + bevacizumab 3 FOLFOX/CAPOX + bevacizumab 2 FOLFOXIRI FOLFIRI/CAPIRI + bevacizumab 1 Encorafenib + binimetinib + cetuximab 1 FOLFIRINOX + bevacizumab 1 1 FOLFIRINOX N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOXIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 8 FOLFIRI/CAPIRI + bevacizumab 1 FOLFOXIRI 1 Encorafenib + binimetinib + cetuximab 1 1 FOLFIRINOX + bevacizumab N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) FOLFOXIRI + bevacizumab 18 2 FOLFOX/CAPOX + bevacizumab FOLFOXIRI 2 Encorafenib + binimetinib + cetuximab 2 FOLFIRINOX + bevacizumab 1 FOLFIRINOX 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 2 2 FOLFOXIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 5-FU/LV + bevacizumab Capecitabine + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFOXIRI + bevacizumab 3 2 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 FOLFIRINOX N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 2 2 FOLFOXIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 5-FU/LV + bevacizumab Capecitabine + bevacizumab 1 N = 26 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFOXIRI + bevacizumab 3 2 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 FOLFIRINOX N = 26 clinical investigators
65
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 7 Encorafenib + binimetinib + cetuximab 6 FOLFIRI/CAPIRI + bevacizumab Irinotecan + cetuximab + vemurafenib 5 3 Irinotecan + panitumumab + vemurafenib FOLFOX/CAPOX + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 1 FOLFOXIRI + bevacizumab 1 Encorafenib + binimetinib + panitumumab 1 Irinotecan N = 26 clinical investigators
66
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) Encorafenib + binimetinib + cetuximab 9 Irinotecan + cetuximab + vemurafenib 7 3 FOLFIRI/CAPIRI + bevacizumab 3 Irinotecan + panitumumab + vemurafenib FOLFOXIRI + bevacizumab 2 Encorafenib + binimetinib + panitumumab 1 1 Dabrafenib + trametinib + panitumumab N = 26 clinical investigators
67
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 7 Encorafenib + binimetinib + cetuximab 6 FOLFIRI/CAPIRI + bevacizumab Irinotecan + cetuximab + vemurafenib 5 Irinotecan + panitumumab + vemurafenib 3 FOLFOX/CAPOX + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 1 FOLFOXIRI + bevacizumab 1 Encorafenib + binimetinib + panitumumab 1 Irinotecan N = 26 clinical investigators
68
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 9 Encorafenib + binimetinib + cetuximab 7 Irinotecan + cetuximab + vemurafenib FOLFIRI/CAPIRI + bevacizumab 3 3 Irinotecan + panitumumab + vemurafenib FOLFOXIRI + bevacizumab 2 Dabrafenib + trametinib + panitumumab 1 Encorafenib + binimetinib + panitumumab 1 N = 26 clinical investigators
69
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 6 FOLFIRI/CAPIRI + bevacizumab 4 Encorafenib + binimetinib + cetuximab 4 Irinotecan + cetuximab + vemurafenib 3 FOLFOX/CAPOX + bevacizumab Irinotecan + panitumumab + vemurafenib 3 2 Irinotecan FOLFOXIRI + bevacizumab 1 1 Dabrafenib + trametinib + panitumumab Capecitabine + bevacizumab 1 N = 25 clinical investigators
70
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 7 Encorafenib + binimetinib + cetuximab Irinotecan + cetuximab + vemurafenib 6 3 FOLFOX/CAPOX + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 2 Irinotecan + panitumumab + vemurafenib 1 FOLFOXIRI + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 Irinotecan + bevacizumab Capecitabine + bevacizumab 1 N = 25 clinical investigators
71
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) FOLFIRI/CAPIRI + bevacizumab 6 Encorafenib + binimetinib + cetuximab 4 Irinotecan + cetuximab + vemurafenib 4 FOLFOX/CAPOX + bevacizumab 3 3 Irinotecan + panitumumab + vemurafenib Irinotecan 2 FOLFOXIRI + bevacizumab 1 1 Dabrafenib + trametinib + panitumumab Capecitabine + bevacizumab 1 N = 25 clinical investigators
72
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Biomarker status: BRAF V600E mutation Tumor location: Right side (RAS wild type) Encorafenib + binimetinib + cetuximab 7 Irinotecan + cetuximab + vemurafenib 6 FOLFOX/CAPOX + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 3 2 Irinotecan + panitumumab + vemurafenib FOLFOXIRI + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 1 Irinotecan + bevacizumab Capecitabine + bevacizumab 1 N = 25 clinical investigators
73
Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 Regorafenib 5 4 Encorafenib + binimetinib + cetuximab Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 N = 24 clinical investigators
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Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 Regorafenib 4 Irinotecan + cetuximab + vemurafenib 3 2 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 1 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 Dabrafenib + trametinib + panitumumab 1 N = 24 clinical investigators
75
Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 5 Regorafenib Encorafenib + binimetinib + cetuximab 4 Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 N = 24 clinical investigators
76
Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 4 Regorafenib Irinotecan + cetuximab + vemurafenib 3 2 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 1 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 Dabrafenib + trametinib + panitumumab 1 N = 24 clinical investigators
77
Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 12 TAS-102 4 Regorafenib Encorafenib + binimetinib + cetuximab 3 3 Supportive care Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 1 Irinotecan + panitumumab + vemurafenib N = 26 clinical investigators
78
Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 13 TAS-102 3 Irinotecan + cetuximab + vemurafenib 3 Supportive care 3 Regorafenib 1 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 1 1 Irinotecan + cetuximab Irinotecan + panitumumab + vemurafenib 1 N = 26 clinical investigators
79
Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 12 TAS-102 4 Regorafenib Encorafenib + binimetinib + cetuximab 3 3 Supportive care Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 1 Irinotecan + panitumumab + vemurafenib N = 26 clinical investigators
80
Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 13 TAS-102 3 Irinotecan + cetuximab + vemurafenib Supportive care 3 Regorafenib 3 Encorafenib + binimetinib + cetuximab 1 FOLFIRI/CAPIRI + bevacizumab 1 1 Irinotecan + cetuximab Irinotecan + panitumumab + vemurafenib 1 N = 26 clinical investigators
81
Do you typically administer BRAF-targeted therapy for your patients with mCRC with BRAF V600E mutations? 24 Yes No 2 N = 26 clinical investigators
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Optimal Management of Microsatellite Instability (MSI) High or DNA Mismatch Repair Deficient (dMMR) mCRC
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First line Second line Third line or beyond
Reimbursement and regulatory issues aside, for a patient with MSI-high mCRC, in what line of therapy would you generally administer an anti-PD-1/ PD-L1 antibody? 7 First line 14 Second line Third line or beyond 5 N = 26 clinical investigators
84
Which of the following checkpoint inhibitors have you administered to a patient with MSI-high mCRC? (Select all that apply.) 23 Pembrolizumab 19 Nivolumab 16 Nivolumab/ ipilimumab Atezolizumab 5 Durvalumab 1 N = 26 clinical investigators
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What is your usual first-line treatment recommendation for a 60-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC? 12 FOLFOX/CAPOX + bevacizumab 5 FOLFOX/CAPOX + EGFR antibody Nivolumab/ipilimumab 3 2 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI 1 Pembrolizumab 1 1 FOLFIRI/CAPIRI + EGFR antibody N = 25 clinical investigators
86
What is your usual first-line treatment recommendation for an 80-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC? FOLFOX/CAPOX + bevacizumab 7 6 Pembrolizumab FOLFOX/CAPOX + EGFR antibody 3 3 Nivolumab/ipilimumab 3 Nivolumab 2 FOLFIRI/CAPIRI 1 FOLFOX/CAPOX Pembrolizumab or nivolumab (“coin flip”) 1 N = 26 clinical investigators
87
What is your usual second-line treatment recommendation for a 60-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who responds to first-line FOLFOX/bevacizumab and experiences disease progression after receiving 9 months of bevacizumab maintenance? 11 Pembrolizumab 8 Nivolumab/ipilimumab FOLFIRI/CAPIRI + bevacizumab 4 2 Pembrolizumab or nivolumab (“coin flip”) Nivolumab 1 N = 26 clinical investigators
88
What is your usual second-line treatment recommendation for an 80-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who responds to first-line FOLFOX/bevacizumab and experiences disease progression after receiving 9 months of bevacizumab maintenance? 14 Pembrolizumab 4 Pembrolizumab or nivolumab (“coin flip”) Nivolumab/ipilimumab 3 3 Nivolumab FOLFIRI/CAPIRI + bevacizumab 2 N = 26 clinical investigators
89
What is your usual third-line treatment recommendation for a 60-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who receives first-line FOLFOX/bevacizumab and second-line FOLFIRI/bevacizumab and is now experiencing disease progression? 13 Nivolumab/ipilimumab 9 Pembrolizumab Nivolumab 3 Pembrolizumab or nivolumab/ipilimumab (“coin flip”) 1 N = 26 clinical investigators
90
What is your usual third-line treatment recommendation for an 80-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who receives first-line FOLFOX/bevacizumab and second-line FOLFIRI/bevacizumab and is now experiencing disease progression? 13 Pembrolizumab 4 Pembrolizumab or nivolumab (“coin flip”) Nivolumab/ipilimumab 4 4 Nivolumab FOLFIRI/CAPIRI + EGFR antibody 1 N = 26 clinical investigators
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HER2 Positivity and Other Potential Biomarkers
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Reimbursement and regulatory issues aside, for a patient with mCRC with HER2 mutation/amplification, in what line of therapy would you generally administer anti-HER2 therapy? 3 First line 11 Second line Third line or beyond 11 1 I would not administer anti-HER2 therapy N = 26 clinical investigators
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For a patient with mCRC with HER2 mutation/amplification to whom you would administer anti-HER2 therapy, which regimen would you recommend? 11 Trastuzumab/pertuzumab 9 Trastuzumab/lapatinib Trastuzumab 5 N = 25 clinical investigators
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