Learn all about oral chemotherapy in this webinar featuring Fight CRC Medical Advisory Board Member Leonard Saltz, MD.

1. OUR WEBINAR WILL BEGIN SHORTLY

2. Everything You Need to Know About
Oral Chemotherapy and CRC

3. Thank you to the following webinar
sponsors:

4. TODAY’S
WEBINAR
01 Ask a question 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
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5. Resources
Fight CRC offers a wide
variety of resources for
those touched by colorectal
cancer. Visit FightCRC.org
to view, download, and
order the latest resources.

6. The information and services 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
Colorectal Cancer
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. “Chemotherapy” = “Drugs”

11. Types of Chemotherapy
• Cytotoxic
• Biologic
• “Targeted”

12. Role of Chemotherapy
• Curative
• Adjuvant
• Neoadjuvant
• Palliative or non-curative

13. Measures of Success:
What does it mean if the chemo “works”?
• Cure
• Survival (Overall Survival)
• Progression-Free Survival
• Response
• “Stable Disease”
• “Disease Control Rate”

14. “Significant” ≠ “Substantial”

15. “Toxicity” = “Side Effects”

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 experience with chemotherapy
has little or nothing to do with what your
experience will be.

18. Oral Chemo Pros and 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 oral chemo 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.

20. Chemotherapy for Colorectal
Cancer

21. Intravenous Chemotherapy Drugs for CRC
• 5-Fluorouracil
• Leucovorin
• Irinotecan
• Oxaliplatin
• Bevacizumab
• Aflibercept
• Ramucirumab
• Cetuximab
• Panitumumab

22. Intravenous Chemotherapy Regimens for CRC
• FOLFOX
• FOLFIRI
• FOLFOXIRI or FOLFIRINOX
Abbreviations:
FOL = leucovorin (folinic acid)
FOLF = leucovorin + fluorouracil (48 hour infusion)
IRI = irinotecan
OX = oxaliplatin

23. Intravenous Chemotherapy Regimens for 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 Drugs for CRC
• Capecitabine (Xeloda ®)
• Regorafenib (Stivarga ®)
• TAS-102 (Lonsurf®)

25. 5-Fluorouracil (5-FU)

26. Why can’t I take 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

27. Capecitabine

28. 5-FU at the center of Capecitabine

29. Capecitabine

31. 5-Fluorouracil (5-FU)

32. Myths and Misconceptions about 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 Effects of Capecitabine
• Hand-foot syndrome
• Diarrhea
• Mouth Sores

35. Capecitabine in Colorectal Cancer
• Single agent
• CapeOx
• Cape/Bev

36. Other Oral Agents in CRC
• Regorafenib
• TAS-102

37. Conclusions
• “Chemotherapy” is simply 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 in your questions on the panel on
the right side of your screen

39. Fight Colorectal Cancer Mission
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.

40. THANK YOU