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August 2020 Webinar Slides
The document is a summary of a webinar focused on oral chemotherapy for colorectal cancer, featuring Dr. Leonard Saltz from Memorial Sloan Kettering. Key topics include the differences between oral and intravenous chemotherapy, common medications, their side effects, and who is suitable for oral chemotherapy. Fight Colorectal Cancer provides resources and support for patients, emphasizing that information is not a substitute for professional medical advice.
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August 2020 Webinar Slides
- 1. OUR WEBINAR WILLBEGIN SHORTLY
- 2. Everything You Needto Know About Oral Chemotherapy and CRC
- 3. Thank you tothe following webinar sponsors:
- 4. TODAY’S WEBINAR 01 Ask aquestion using the Q&A button on the bottom of your screen QUESTIONS 02 Watch a recording of this webinar on the Fight CRC website. Visit FightCRC.org WEBINAR ARCHIVE 03 Follow along on Twitter. Use the hashtag #CRCWebinar TWEET ALONG!
- 5. Resources Fight CRC offersa wide variety of resources for those touched by colorectal cancer. Visit FightCRC.org to view, download, and order the latest resources.
- 6. The information andservices provided by Fight Colorectal Cancer are for general informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnoses or treatment. If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room. Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition.
- 7. TODAY’S PRESENTER Leonard Saltz, MD Dr.Saltz has been on the faculty of Memorial Sloan Kettering since 1989, and over the years has treated thousands of people with common as well as rare gastrointestinal cancers. He has particular expertise in managing cancers of the colon and rectum, as well as rare tumors of the digestive tract such as carcinoid and pancreatic neuroendocrine tumors, and other digestive tract cancers such as liver, pancreas, stomach, and esophagus cancers. He also treats other neuroendocrine tumors such as adrenal cancers and pheochromocytomas. Much of his career has also been dedicated to developing new drug therapies and treatment strategies for colorectal cancer, and has tapped the vast resources of Memorial Sloan Kettering — from various clinical departments to the Human Oncology and Pathogenesis Program, the Sloan Kettering Institute, and The Rockefeller University — to create an integrated translational research program. He has served as Chief of the Gastrointestinal Medical Oncology Service for 5 years. He is the Chair of the hospital’s Pharmacy and Therapeutics Committee and co-leader of the Colorectal Disease Management Team. He is also a Professor of Medicine at Weill Cornell Medical College.
- 8. Oral Chemotherapy in ColorectalCancer Leonard B. Saltz, MD FightColorectalCancer.org Medical Advisory Board Member Professor of Medicine, Weill Cornell Medical College Attending Physician, Memorial Sloan Kettering Cancer Center New York, NY USA
- 9. Overview • What is“chemotherapy”?? • How does oral chemotherapy compare with intravenous (IV)?? • What are common forms of oral chemotherapy for CRC patients?? • How do I take oral chemotherapy??
- 10.
- 11. Types of Chemotherapy •Cytotoxic • Biologic • “Targeted”
- 12. Role of Chemotherapy •Curative • Adjuvant • Neoadjuvant • Palliative or non-curative
- 13. Measures of Success: Whatdoes it mean if the chemo “works”? • Cure • Survival (Overall Survival) • Progression-Free Survival • Response • “Stable Disease” • “Disease Control Rate”
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- 15. “Toxicity” = “SideEffects”
- 16. Chemotherapy Side Effects: Remember: •Different drugs have different side effects. • Different people may get different side effects from the same drug. • Different people on the same drug may get the same side effect(s) to a different degree.
- 17. Chemotherapy: Remember: •Another person’s experiencewith chemotherapy has little or nothing to do with what your experience will be.
- 18. Oral Chemo Prosand Cons Advantage of Oral • Can take at home • Fewer visits to clinic • Does not need a needle • Does not need a port. Disadvantages of Oral • Responsibility put on patient • Must be able to eat • Must be able to swallow pills • Possible co-pays (financial toxicity)
- 19. Who is oralchemo a good choice for? • Motivated patient • Willing and able to keep track and maintain schedule • Able to assess own side effects and communicate with provider • Able to eat normally and swallow (large) pills.
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- 21. Intravenous Chemotherapy Drugsfor CRC • 5-Fluorouracil • Leucovorin • Irinotecan • Oxaliplatin • Bevacizumab • Aflibercept • Ramucirumab • Cetuximab • Panitumumab
- 22. Intravenous Chemotherapy Regimensfor CRC • FOLFOX • FOLFIRI • FOLFOXIRI or FOLFIRINOX Abbreviations: FOL = leucovorin (folinic acid) FOLF = leucovorin + fluorouracil (48 hour infusion) IRI = irinotecan OX = oxaliplatin
- 23. Intravenous Chemotherapy Regimensfor CRC • FOLFOX • FOLFIRI • FOLFOXIRI or FOLFIRINOX Often given with a biologic, such as: Bevacizumab (Avastin ®, Mvasi®, or other biosimilar) Panitumumab (Vectibix ®) Cetuximab (Erbitux®)
- 24. Oral Chemotherapy Drugsfor CRC • Capecitabine (Xeloda ®) • Regorafenib (Stivarga ®) • TAS-102 (Lonsurf®)
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- 26. Why can’t Itake 5-FU by mouth? • Absorbs through the small intestines • First taken to the liver • Enzyme in liver (called DPD) breaks down 5-FU • DPD levels vary widely from person to person
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- 28. 5-FU at thecenter of Capecitabine
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- 32. Myths and Misconceptionsabout Oral Chemo • Oral does NOT mean less effective or less aggressive. • Oral does NOT mean fewer or milder side effects. • Oral does NOT necessarily mean easier. • Oral is neither better nor worse: it is simply different. • Oral is not for everyone; it is a good choice for SOME patients.
- 33. Capecitabine Treatment Schedule •Based on body surface area (calculated from height and weight) • 500 mg tablets…..usually 3-4 tablets per dose • Dosed twice a day, 14 days on, 7 days off • Take after meals
- 34. Common Side Effectsof Capecitabine • Hand-foot syndrome • Diarrhea • Mouth Sores
- 35. Capecitabine in ColorectalCancer • Single agent • CapeOx • Cape/Bev
- 36. Other Oral Agentsin CRC • Regorafenib • TAS-102
- 37. Conclusions • “Chemotherapy” issimply another word for “drugs.” • Some drugs are given by intravenous (IV) injection and some by mouth. • All drugs can have side effects. • Oral is neither better nor worse than IV; it is simply different.
- 38. QUESTION AND ANSWER Type inyour questions on the panel on the right side of your screen
- 39. Fight Colorectal CancerMission We FIGHT to cure colorectal cancer and serve as relentless champions of hope for all affected by this disease through informed patient support, impactful policy change, and breakthrough research endeavors.
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