Evolving mCRC Care: A Six-Year Journey to Sustained Quality of Life

Evolving mCRC Care

A Journey to Sustained Quality of Life

Year Journey

Patient Profile

64-Year-Old Male (at diagnosis)

RAS/BRAF Wild-Type

Left-Sided Primary Tumor

ECOG Performance Status: 0

Treatment Timeline

2016

Initial Diagnosis

Rectal Mass, XELOX + RT

2018

Recurrence & 1st Line

FOLFOX + Cetuximab

Maintenance & 2nd Line

5FU + Cetuximab, then FOLFIRI

2021

3rd Line & Novel Combo

CAPability-01 Trial

1st Line: Precision Targeting

For the RAS/BRAF wild-type, left-sided tumor, the choice was FOLFOX + cetuximab. This was guided by retrospective data from trials like PEAK and FIRE-3, favoring anti-EGFR therapy for improved survival in this specific patient subgroup.

Response: Non-CR/Non-PD

Primary toxicities: Grade 2 rash and neuropathy.

Maintenance & Sequential Therapy

After induction, the patient transitioned to maintenance with 5FU + cetuximab for 17 months. Upon progression, the strategy evolved:

2nd Line: FOLFIRI + bevacizumab (6 months, stable disease).
Followed by: Capecitabine + bevacizumab (led to progression).

3rd Line: The "Aha!" Moment

By 2021, standard options were limited. The patient enrolled in the CAPability-01 trial, a novel combination of an HDAC inhibitor, a PD-1 inhibitor, and an angiogenesis inhibitor.

Achieved First-Ever

Partial Response

Significant tumor shrinkage in lung lesions.

Response Over Time

Key Takeaways

Molecular Profiling is Critical

RAS/BRAF wild-type status was fundamental in guiding effective first-line anti-EGFR therapy for a left-sided primary.

Dynamic Treatment Evolution

The journey from induction to maintenance, and through multiple lines of therapy, shows mCRC management is a constantly adapting process.

Sustained Quality of Life is Possible

Over six years with advanced disease is achievable with precise, evidence-based, and sometimes experimental treatment choices.

The Future is in Innovation

Exploring novel combinations in clinical trials can unlock significant responses, transforming experimental approaches into future standards of care.