1. Dr Francis Daniel, MB. ChB, FFR-RCSI, FRCR. Consultant in Clinical Oncology www.bowelcancerwest.org.uk

2. What is new in Colorectal Cancer Oncology?

3. www.bowelcancerwest.org.uk  Local disease: Colon, Adjuvant treatment.  Local disease: Rectum, Pre-op RT.  Metastatic disease: New combinations, New agents.  Cancer Drug Fund.

4. www.bowelcancerwest.org.uk Adjuvant Treatment (Colon&Rectum)  Flurouracil: 5-10 %  Capecitabine: 5-10%  Combination Chemotherapy (Oxaliplatin+Capecitabine): 15-20%

5. www.bowelcancerwest.org.uk Pre operative RT for Rectal tumour  Selection is now refined (MRI selective criteria)  Short Course RT (Mainly for low rectum requiring APR)  Long course RT with chemo (Down staging when margin is threatened)

6. www.bowelcancerwest.org.uk Before After

7. www.bowelcancerwest.org.uk Before After

8. www.bowelcancerwest.org.uk  Oxaliplatin + Capecitabine = 40% Response rate.  Irinotecan and Capecitabine = 40%  Cetuximab added = extra 10%  Bevacizumab added = extra 10% Combination Chemotherapy for advanced diseases

9. www.bowelcancerwest.org.uk Cancer Drug Funds Bevacizumab and Cetuximab

10. www.bowelcancerwest.org.uk Vascular Epidermal Growth Receptor  VEGFR1 and VEGFR2 are expressed on the surface of blood endothelial cells. There is evidence that VEGFR2 is the major mediator of endothelial cell mitogenesis, survival and microvascular permeability. Bevacizumab block this receptors

11. www.bowelcancerwest.org.uk Bevacizumab

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

13. www.bowelcancerwest.org.uk Cetuximab

14. Thank you for listening Any questions? Any questions?