Find Effective Drugs before Starting the Therapy!

No two cancer therapies are the same!

There is a wide range of different drugs which can be applied in treatment of colorectal cancer. This treatment includes classical chemotherapeutic substances, yet also new targeted drugs are used. Which medication should be prescribed depends on different factors, e.g. the cancer stage and the general condition of the patient. In order to choose the right therapy there are medical guidelines for physicians. However, in some situations the guidelines do not give clear recommendations and propose equivalent treatment options.

Diagnostic assays can help to identify effective and ineffective drugs before the start of a therapy. The available spectrum of therapeutics can thereby be limited on the most promising substances. Our diagnostics contribute avoidance of unnecessary side effects as a consequence of an ineffective therapy and save valuable treatment time. Therefore we offer the following diagnostic tests:

 

  • CTR-Test® - An efficacy test working on living tumor cells

  • PCDx™ - A tumor-biomarker-analysis working on non-living, conserved tumor cells

  • Guardant360®- A tumor-biomarker-analysis working with blood


Guidelines for the Treatment of Colorectal Cancer

Hereafter you can find an overview about guideline-recommendations, which are elaborated by medical specialist associations:
 

Colorectal cancer is classified into four stages. For the first three stages the therapy is a curative one, which aims for a complete cure.

In the fourth stage a palliative therapy aims for an improvement of quality of life. It has to be determined if metastases are surgically removable and if a mutation of the RAS-gene, a protooncogene, exists.

Stage I (curative) after operation no further chemotherapy
Stage II (curative) fluoropyrimidine*
Stage III (curative) fluoropyrimidine* + oxaliplatin
in presence of contraindications against oxaliplatin fluoropyrimidine*
Stage IV (palliative) surgically removable metastases fluoropyrimidine* + oxaliplatin and/or Irinotecan +/- anti-EGRF antibody**
fluoropyrimidine* +  oxaliplatin and/or irinotecan +/- bevacizumab
non-surgically removable metastases and RAS mutation fluoropyrimidine* + oxaliplatin and/or irinotecan +/- bevacizumab
monotherapy
non-surgically removable metastases and no RAS mutation fluoropyrimidine* + oxaliplatin or irinotecan + anti-EGRF antibody**
fluoropyrimidine* + oxaliplatin and/or irinotecan +/- bevacizumab
monotherapy

*fluorpyrimidine are e.g. 5-fluorouracil or capecitabine

**anti-EGRF antibodies are e.g. cetuximab or panitumumab

This table is based on the "Evidenced-based Guideline for Colorectal Cancer", issued by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF) [1], and the "Leitlinie Kolonkarzinom" from the German Society for Haematology and Medical Oncology (Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie e.V., DGHO), published on onkopedia.de [3].


Efficacy Tests of Drugs for Colorectal Cancer

Which drugs can be tested in their efficacy by our diagnostic tests? The following tables give you information on the substances recommended by the guidelines, but also about further drugs which can be found as additional treatment options in literature. These substances are classified in the following categories:

In addition the frequently used combination therapies are listed below.

The testabilities for the CTR-Test®  and the PCDx™ are also given.


Chemotherapeutics

substance name

efficacy testable by

CTR-Test Logo

efficacy testable by

PCDx Logo

efficacy testable by

Guardant360 Logo

Referenz
capecitabine yes yes

not yet

[1], [2], [3], [4]
fluorouracil yes yes not yet [1], [2], [3], [4]
irinotecan yes yes not yet [1], [2], [3], [4]
mitomycin C yes yes not yet [1], [2]
oxaliplatin yes yes yes [1], [2], [3], [4]
 

Targeted Drugs

substance name

efficacy testable by

CTR-Test Logo

efficacy testable by

PCDx Logo

efficacy testable by

Guardant360 Logo

Referenz
aflibercept no no biomarkers yet not yet [2]
bevacizumab no yes not yet [1], [2], [3], [4]
cetuximab no validation yet yes yes [1], [2], [3], [4]
panitumumab no validation yet yes yes [2], [3], [4]

 

Frequently Used Combination Therapies

substance name combination name reference
5-fluorouracil + aflibercept + irinotecan Folfiri/Aflibercept          [2]
5-fluorouracil + bevacizumab [1]       
5-fluorouracil + bevacizumab + irinotecan Folfiri/Bevacizumab [1], [2], [3], [4]
5-fluorouracil + bevacizumab + irinotecan + oxaliplatin Folfoxiri/Bevacizumab         [1], [2], [3], [4]
5-fluorouracil + bevacizumab + oxaliplatin Folfox/Bevacizumab [1], [3], [4]       
5-fluorouracil + cetuximab + irinotecan Folfiri/Cetuximab [1], [2], [3], [4]       
5-fluorouracil + cetuximab + oxaliplatin Folfox/Cetuximab [1], [3], [4]
5-fluorouracil + irinotecan Folfiri [1], [2], [3], [4]
5-fluorouracil + irinotecan + oxaliplatin Folfoxiri [1], [2], [3], [4]
5-fluorouracil + irinotecan + panitumumab Folfiri/Panitumumab [2], [3], [4]
5-fluorouracil + oxaliplatin Folfox [1], [2], [3], [4]
5-fluorouracil + oxaliplatin + panitumumab Folfox/Panitumumab [2], [3], [4]
5-fluorouracil + mitomycin C [1]
bevacizumab + capecitabine + irinotecan Caplri/Bevacizumab [2], [3]
bevacizumab + capecitabine + oxaliplatin Xelox/Bevacizumab [1], [3], [4]
capecitabine + irinotecan Caplri [1], [2], [3]
capecitabine + oxaliplatin Xelox [1], [2], [3], [4]
cetuximab + irinotecan [1], [2]

The drugs listed here were identified as potential therapy options after an accurate literature research. Completeness cannot be guaranteed. Status: September 2016.


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