Colorectal cancer continues to be a high-ranking cause of morbidity and mortality across the US. The estimated cases for 2021 reach above 150,000 new occurrences and nearly 53,000 deaths. Incidence of colorectal cancer can be decreased through expanded screening designed to help detect the disease at a more curable stage. Unfortunately, approximately one-third of those who are eligible for screening remain unchecked. Updated 2021 clinical guidelines for colorectal cancer screening have been put forth by the American College of Gastroenterology (AGC) that refresh its previous guidelines from 2009 and incorporate approaches intended to boost screening rates.

The AGC continues to strongly recommend that colorectal cancer screening occurs for individuals aged 50 to 75 years. It has also now suggested that screenings be initiated even earlier in life, starting at age 45. The decision for screening being offered to a patient over the age of 75 should be individualized. The primary screening modalities are colonoscopy and fecal immunochemical testing. For patients who may be unable or unwilling to participate in either of these modalities, the AGC has added colon capsule as a screening option, in addition to the alternatives of flexible sigmoidoscopy, multitarget stool DNA testing, and CT colonography. For individuals with a first-degree relative with colorectal cancer at age ≥60, the suggestion is to initiate screening at age 40 or 10 years before the youngest affected relative. There are also suggestions regarding the use of low-dose aspirin for individuals aged between 50 and 69 years. All details regarding the updated guidelines can be viewed in full at the American Journal of Gastroenterology Clinical Guidelines webpage.

Screening is imperative for detecting cancer at an early stage, but more advanced therapies targeting rarer and more challenging patient populations are also essential for combating the disease. A recent FDA approval for a unique combination therapy is one such targeted treatment that is helping bring longer life and improved quality of life to some individuals. The approval covered the use of Braftovi (encorafenib) in combination with Erbitux (cetuximab) in adult patients with BRAF V600E–mutated metastatic colorectal cancer and who have already undergone treatment. Encorafenib is a BRAF inhibitor with markedly prolonged pharmacodynamic activity, and cetuximab is a monoclonal antibody that is highly selective for EGFR. The studies leading to the approval of the combination therapy successfully confirmed that patients who received the doublet treatment experienced significantly improved overall survival and tumor response rates compared to those who received the standard treatment of cetuximab plus chemotherapy. Some patients treated with encorafenib and cetuximab in the studies experienced side effects such as fatigue, weakness, nausea, rash, and diarrhea.

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