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Dr Francis Daniel, MB. ChB, FFR-RCSI, FRCR. Consultant in Clinical Oncology

Dr Francis Daniel, MB. ChB, FFR-RCSI, FRCR. Consultant in Clinical Oncology. www.bowelcancerwest.org.uk. What is new in Colorectal Cancer Oncology?. www.bowelcancerwest.org.uk. Local disease: Colon, Adjuvant treatment. Local disease: Rectum, Pre-op RT.

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Dr Francis Daniel, MB. ChB, FFR-RCSI, FRCR. Consultant in Clinical Oncology

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  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? www.bowelcancerwest.org.uk

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

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

  5. 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) www.bowelcancerwest.org.uk

  6. Before After www.bowelcancerwest.org.uk

  7. Before After www.bowelcancerwest.org.uk

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

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

  10. 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 www.bowelcancerwest.org.uk

  11. Bevacizumab www.bowelcancerwest.org.uk

  12. Epidermal Growth Factor Receptor • 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. www.bowelcancerwest.org.uk

  13. Cetuximab www.bowelcancerwest.org.uk

  14. Thank you for listening Any questions? www.bowelcancerwest.org.uk

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