What options remain when a patient with microsatellite stable metastatic colorectal cancer (MSS mCRC) has progressed through every standard line of chemotherapy? On this episode of BackTable Tumor Board, Dr. Jun Gong is joined by Dr. Ibrahim Sahin and Dr. Sandra Algaze to explore the nuances of late-line management in MSS-mCRC. They discuss how to approach oxaliplatin retreatment and anti-EGFR rechallenge, the growing role of liquid biopsy and biomarker-driven selection, and the practicalities of DPYD testing after recent guideline changes.

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Timestamps

00:00 – Introduction
01:55 – Oxaliplatin Retreatment and Anti-EGFR Rechallenge
07:53 – DPYD Testing and Liquid Biopsy
14:00 – Comparing Rechallenge and Conventional Agents
15:42 – STELLAR-303 and Third-Line Options
22:53 – Immunotherapy and MSS Biology
25:42 – SUNLIGHT, FRESCO-2, and CORRECT Trials
30:41 – Alternative Dosing Strategies
32:02 – Botensilimab and Balstilimab Update
37:06 – Neoadjuvant Immunotherapy
38:15 – Emerging Antibody-Drug Conjugates
42:02 – Closing Remarks

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More about this episode

The conversation walks through the latest clinical trial results for third-line and beyond, including strategies for dosing and tolerability, and the unique challenges posed by liver metastases. Drs. Sahin and Algaze highlight new developments in immunotherapy, antibody-drug conjugates, and bispecific antibodies, as well as the importance of matching therapy to both tumor biology and patient needs. They close with insights on patient monitoring, toxicity management, and the value of multidisciplinary care for this complex population.

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Resources

STELLAR-303: Zanzalintinib Plus Atezolizumab Versus Regorafenib in Refractory Colorectal Cancer (The Lancet)
https://pubmed.ncbi.nlm.nih.gov/41130252/

SUNLIGHT: Trifluridine-Tipiracil and Bevacizumab in Refractory Metastatic Colorectal Cancer (NEJM)
https://www.nejm.org/doi/full/10.1056/NEJMoa2214963

FRESCO-2: Fruquintinib Versus Placebo in Refractory Metastatic Colorectal Cancer (The Lancet)
https://www.thelancet.com/article/S0140-6736(23)00772-9/abstract

CAPRI-2 GOIM: Liquid Biopsy Genomic Profiling to Predict FOLFIRI Plus Cetuximab Efficacy (ESMO Open)
https://www.esmoopen.com/article/S2059-7029(25)00380-1/fulltext

Botensilimab Plus Balstilimab in Relapsed/Refractory MSS Metastatic Colorectal Cancer (Nature Medicine)
https://www.nature.com/articles/s41591-024-03083-7

Phase I Study of Telisotuzumab Adizutecan (ABBV-400), a c-Met Antibody-Drug Conjugate, in Late-Line Colorectal Cancer (JCO)
https://ascopubs.org/doi/10.1200/JCO-25-01525

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BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care.

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