Leading German-American colorectal cancer oncologist discusses current paradigm shift in strategy of colorectal cancer treatment. “I think we are living in a very interesting time for colon cancer treatment. Today I can cure a metastatic colorectal cancer patient. It doesn't mean all metastatic colon cancer patients are cured. But the goal of metastatic colon cancer therapy would be cure.”

How do we use our treatment options at the time of metastatic colon cancer diagnosis? then if there is tumor progression, what is the next line of treatment options? Should we calculate a new colon cancer treatment strategy? Advanced colon cancer treatment strategy. A paradigm shift. Precision medicine progress in colon cancer treatment requires paradigm shift in colorectal cancer treatment strategy. We should not wait for colon cancer tumor to recur. We should follow a molecular profile of the tumor. It's important to establish a treatment goal for colon cancer patient. I can cure a metastatic colorectal cancer patient. We have more advanced colon cancer treatment options than ever before. We can choose between multi-tyrosine kinase inhibitor, oral cytotoxic medications, or another chemotherapy cocktail. New medications Ramucirumab (IMC-1121B, Cyramza) are available. Colorectal cancer new targeted chemotherapy options. Refractory stage 4 colon cancer treatment by targeted chemotherapy. Medical second opinion confirms colorectal cancer diagnosis at genetic level. Medical second opinion also confirms colon cancer cure is possible in metastatic colon cancer. Best precision medicine treatment for advanced stage 4 colon cancer with metastatic lesions. Medical second opinion helps to select a personalized medicine targeted treatment for stage 4 colorectal cancer with liver or lung metastases. Get medical second opinion on advanced colorectal cancer. Be confident that your precision medicine treatment is the best. Best colorectal cancer treatment by new BRAF inhibitors, EGFR inhibitor monoclonal antibodies, anti-angiogenesis medications and multikinase inhibitors. Video interview with leading expert in metastatic colorectal cancer treatment from California.

Advanced colon cancer treatment options. Dr. Anton Titov, MD. We spoke a lot about specific colon cancer treatments. We discussed use of molecular markers in personalized colon cancer therapy. But it's important to put colorectal cancer treatment in context. You published a very important colon cancer treatment options review. Your article suggested that now is the time for a paradigm shift in colorectal cancer treatment options.

Colorectal cancer therapy selection usually is based on so-called "lines of therapy". When "first line" colon cancer chemotherapy fails, then you go to the "second line" of chemotherapy. You say that now colon cancer treatment should move from line-based approach to a "chronic disease management". We should not wait for colon cancer tumor to recur but we should follow a molecular profile of the tumor. We should follow the temporal molecular profile of colon cancer tumor during chemotherapy.

Could you please describe this paradigm shift in approach to treatment of colon cancer and rectal cancer? Dr. Heinz-Josef Lenz, MD (Colorectal Cancer Expert, California). Yes, I think we are living in a very interesting time for colon cancer treatment. We understand more and more the behavior of colon cancer. It is associated with certain molecular alterations in the tumor. We know some tumors have a certain genetic alteration of BRAF or KRAS or MSI (Microsatellite Instability). Then cancer will behave differently. Colon cancer tumors will metastasize to different organs of the body. It will be very important in our clinical practice to establish a treatment goal for colon cancer patient. Some patients come in with oligometastatic colon cancer. It means colon cancer tumor spread only to the liver or the lung. In this situation today, I think I can cure a metastatic colorectal cancer patient. It doesn't mean all metastatic colon cancer patients are cured. But the goal of metastatic colon cancer therapy would be cure.

When the goal of colon cancer cancer treatment is cure, you select the most aggressive chemotherapy regimen with the most appropriate monoclonal antibody medication. Dr. Heinz-Josef Lenz, MD (Colorectal Cancer Expert, California). Then you have a chance to shrink metastatic colon cancer tumor. Then you control the metastatic colon cancer tumor. Then you do a curative resection of metastatic lesions. Sometimes patients have significant metastatic colon cancer disease. It spreads out in different organs. Then the goal of colon cancer therapy is palliative care. We will choose a treatment regimen this is highly effective. But palliative colon cancer treatment should also be balanced out with the side effect profiles of medications. I would not use the most aggressive chemotherapy regimen for palliative care in patients with advanced metastatic colon cancer. I would still use a very effective chemotherapy regimen. We can now choose between different regimens this have good efficacy but also a very good side effects profile. This allows us to ensure and guarantee a good quality of life for patients with advanced colon cancer.

With a lot of treatment options for colon cancer available now, the challenge will be this. How do we use our treatment options at the time of metastatic colon cancer diagnosis? If there is tumor progression, what is the next line of treatment options? Should we calculate a new colon cancer treatment strategy? Should we biopsy the metastatic colon cancer tumor again? Now we have more advanced colon cancer treatment options open than ever before. We can now choose between multi-tyrosine kinase inhibitor, oral cytotoxic medications, or another chemotherapy cocktail. For example, we can use irinotecan vs. oxaliplatin. We can mix them with antibodies such as Ramucirumab (IMC-1121B, Cyramza) or an EGFR inhibitor. Those medications were not previously used in the first line of colorectal cancer treatment. Dr. Heinz-Josef Lenz, MD (Colorectal Cancer Expert, California). I think we have now really good options for advanced colon cancer treatment. We can now review and tailor these colorectal cancer therapy options based on the treatment goal. We can tailor colon cancer treatment to the patient's condition. We have to know what the patient is all about. We can choose treatments to maintain a very good overall survival. We can maintain a good quality of life for patients with advanced colon cancer. Because our goal with chemotherapy in advanced colon cancer is to extend life. But our goal is also to extend quality of life. The best palliation in advanced colon cancer is effective chemotherapy. Colon cancer treatment is changing dramatically. Old "line of therapy" strategy is becoming obsolete. New method to therapy selection is based on molecular profile of the tumor and molecular profile of the patient.