Download What Is Metastatic colon cancer

What is metastatic colon cancer (MCC)?
Colon cancer, like other cancers, happens when
normal colon cells become abnormal and grow out of
control. This growth forms tumors and may spread
outside of the colon. Colon cancer is called metastatic
when the tumor has grown into nearby areas, or when
it has spread to the lymph nodes or bones. The most
common form of colon cancer is called colon
adenocarcinoma.
Common chemotherapy regimens are known by their
abbreviations—FOLFOX, FOLFIRI, and CapeOX (see
Table 1).
Once colon cancer becomes metastatic, chemotherapy
can help shrink tumors or slow their growth, but it is
unlikely to kill all the cancer cells. In addition to
attacking cancer cells chemotherapy medications also
damage healthy cells, which can cause many side
effects.
How is MCC treated?
What is targeted therapy?
Colon cancer can be treated with a combination of
surgery, radiation, and/or medication. Surgery is used
to remove the cancer from the colon. Medication may
be used when: surgery is not an option; to shrink
tumors before surgery; if surgery cannot remove all of
the cancer; or if the cancer has spread. Medication
options include chemotherapy and targeted therapy.
Targeted therapy focuses on unique features of specific
cancer cells—such as blocking proteins needed by
certain tumors to grow. Medications for targeted
therapy may be used alone, or in combination with
chemotherapy treatment.
What is chemotherapy?
Chemotherapy can stop the abnormal growth of cancer
cells. Treatment usually consists of several medications
taken together (a “regimen”), though single
medications are sometimes used. Chemotherapy
medications for MCC include 5-FU, irinotecan,
oxaliplatin, and capecitabine (Xeloda®).
Targeted therapies for MCC include bevacizumab
(Avastin®) and ziv-aflibercept (Zaltrap®), which block
formation of new blood vessels in tumors; cetuximab
(Erbitux®) and panitumumab (Vectibix®), which block
“epidermal growth factor receptor” (EGFR) on cells
with too much EGFR protein; and regorafenib
(Stivarga®), which blocks a protein that helps cancer
cells multiply and survive.
Continued
Table 1. Medication Options for Metastatic Colon Cancer
Medication
PA? Route
Frequency
Cost a
Effectiveness Evidence
Improves overall Fair
survival by several
months
Chemotherapy Regimens
b
IV
Every 2 weeks
$1,200
FOLFIRI c
IV
Every 2 weeks
$500
CapeOX d
IV + oral
Every 3 weeks
$3,200
capecitabine (Xeloda®)
Oral
Twice daily
$2,900
FOLFOX
Preferred
Targeted Therapy
Preferred
bevacizumab (Avastin®)

IV
Every 2 weeks
cetuximab (Erbitux®)

IV
Every week
IV
Every 2 weeks
panitumumab
Nonpreferred
(Vectibix®)
regorafenib (Stivarga®)

Oral
Once daily
ziv-aflibercept (Zaltrap®)

IV
Every 2 weeks
$5,100
Improves overall
$10,200 survival by a
couple months
$8,700 compared to
$9,700 chemotherapy
alone
$10,700
Poor
Fair
Poor
Poor
Poor
Approximate cost estimates based on a 30-day supply. Actual prices may vary depending on your pharmacy and amount or strength of medication
dispensed. b 5-FU + leucovorin + oxaliplatin. c 5-FU + leucovorin + irinotecan. d Xeloda + oxaliplatin. PA = requires Prior Authorization.
a
Revised Sept. 2014
© 2014 OmedaRx
Are there differences in side effects from MCC
treatments?

Common side effects from chemotherapy include
low blood counts, feeling tired, nausea, and hair loss.
Other serious side effects are possible and vary
between medications.
Targeted therapies usually have fewer side effects
than chemotherapy. Common side effects include skin
changes, nausea, feeling tired, and diarrhea. Other
serious side effects (bleeding problems, blood pressure
changes, liver changes, and intestinal perforation) are
possible and vary between medications.
How well do these treatments work?
The choice of therapy and medication to treat MCC is
often patient-specific. Different combinations may be
used over the course of treatment. Both chemotherapy
and targeted therapy can help shrink tumor size,
reduce pain, and also possibly prolong survival for
some patients. There is no specific medication,
therapy, or treatment regimen proven to cure MCC,
however.
Ziv-aflibercept (Zaltrap) is recommended for
use in combination with FOLFIRI for MCC
patients previously treated with chemotherapy
regimens containing oxaliplatin. It is unknown
whether ziv-aflibercept (Zaltrap) is effective in
patients who have not taken oxaliplatin.
The Bottom Line

Medication options for treatment of metastatic
colon cancer (MCC) include chemotherapy,
targeted therapy, or a combination of the two.

The type of therapy or medication used to treat
MCC usually differs depending on the patient and
stage of their disease.

Some medications used in MCC are
recommended only for patients who meet certain
treatment criteria.

Although effectiveness, safety, and cost of
medications vary, none are proven to cure MCC.
Why do some MCC medications require prior
authorization?
Prior authorization helps ensure cancer medications
are used for treatment situations where they are
proven to be safest and most effective:

Bevacizumab (Avastin) is only recommended
for MCC when used in combination with a
chemotherapy regimen containing 5-FU. It is
unknown how effective bevacizumab (Avastin) is
when used without 5-FU.

Cetuximab (Erbitux) is only recommended for
MCC patients with no mutations in a gene named
“KRAS.” Studies show cetuximab (Erbitux) is not
effective in patients with KRAS mutations (tests
are available to check for these mutations).

Regorafenib (Stivarga) has been studied only
in MCC cases previously treated with a number of
other regimens, and is recommended exclusively
for patients who have tried several different
medications.
Note: Since many medication options are available, our physicians and pharmacists developed this ConsumerRx to provide you
with information about the available alternatives, as well as potential advantages and lack of advantages of the various
products. This medication summary was developed based upon an evaluation of information from the US Food and Drug
Administration (FDA), scientific studies, and input from practicing doctors and specialists.
Revised Sept. 2014
© 2014 OmedaRx