Advanced Colon Cancer Treatment with TAS-102 (Lonsurf) and 5-FU Chemotherapy

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• Enduring Role of 5-FU in Colon Cancer
• Thymidylate Synthase Pathway Importance
• TAS-102 (Lonsurf) Mechanism of Action
• TAS-102 Treatment Approval Status
• Future of Colon Cancer Treatment Selection
• Full Transcript

Enduring Role of 5-FU in Colon Cancer

Dr. Heinz-Josef Lenz, MD, emphasizes that 5-Fluorouracil (5-FU) remains the most effective chemotherapy medication for colon cancer. This is true even with the development of many new targeted therapies. He notes that initial hopes that antibodies would replace classic cytotoxic treatments like 5-FU did not materialize. Instead, new targeted medications are added to the chemotherapeutic backbone that 5-FU provides.

Thymidylate Synthase Pathway Importance

Dr. Heinz-Josef Lenz, MD, explains the critical nature of the fluoropyrimidine pathway. Dr. Heinz-Josef Lenz, MD, states that 5-FU targets an enzyme called thymidylate synthase. This enzyme is vital for DNA synthesis, making its inhibition particularly effective against fast-growing cancer cells. This pathway is so fundamental that it is crucial for the survival of both normal and cancerous cells.

This mechanism is the foundation for common modern chemotherapy protocols. 5-FU is combined with other agents like irinotecan or oxaliplatin to form regimens known as FOLFIRI and FOLFOX. These combinations are the backbone of treatment for metastatic stage 4 colon cancer.

TAS-102 (Lonsurf) Mechanism of Action

TAS-102 (Lonsurf) is a new advanced colon cancer medication that also targets the fluoropyrimidine pathway. Dr. Lenz describes how TAS-102 inhibits this critical molecular pathway in a slightly different way than 5-FU. The most significant advantage of TAS-102 is its ability to work in refractory cancers. It can reduce tumors even when standard 5-FU-based chemotherapy has stopped being effective.

TAS-102 Treatment Approval Status

Dr. Heinz-Josef Lenz, MD, provides an update on the global regulatory status of TAS-102. The medication was already approved for advanced stage 4 colon cancer treatment in Japan at the time of the discussion. Dr. Lenz confirms that TAS-102 was expected to gain approval in the United States by the end of that year. He also expresses confidence that Europe would follow closely with its own approval for the treatment of refractory colorectal cancer.

Future of Colon Cancer Treatment Selection

Dr. Lenz looks ahead to the evolution of precision medicine in oncology. He envisions a future treatment strategy where doctors first select the optimal chemotherapy backbone. This decision will be guided by a molecular profile of the patient's colon cancer tumor. Doctors will then layer on the best targeted treatment based on the tumor's specific genetic profile.

Dr. Anton Titov, MD, facilitates this insightful discussion on the integration of new and classic therapies. The conversation underscores that cytotoxic chemotherapies like 5-FU and TAS-102 remain a profoundly effective part of the oncologist's toolkit. They provide necessary tumor shrinkage and form a critical component of combination therapies for advanced disease.

Full Transcript

The full transcript of the interview between Dr. Anton Titov, MD, and Dr. Heinz-Josef Lenz, MD, is provided above. It offers a comprehensive look at the role of 5-FU, the mechanism of TAS-102, and the future of treatment selection in metastatic colorectal cancer.

Full Transcript

Dr. Heinz-Josef Lenz, MD: TAS-102 is a new member of the 5-fluorouracil and methotrexate family. It has been used successfully in colorectal cancer treatment for 50 years. I think even today, 5-fluorouracil (5-FU) is the most effective chemotherapy medication in colon cancer. But TAS-102 can reduce tumors even when 5-FU does not work anymore.

TAS-102 (Lonsurf) in advanced colon cancer treatment targets the fluoropyrimidine pathway in refractory colorectal cancer. 5-fluorouracil and methotrexate are the backbone of colorectal cancer chemotherapy for 50 years. 5-FU is still very effective chemotherapy for colon cancer.

Even today, 5-fluorouracil is the most effective chemotherapy medication in colon cancer. 5-fluorouracil (5-FU) is a very critical pathway for the survival of normal and cancer cells. TAS-102 (Lonsurf) for advanced stage 4 colon cancer treatment is approved in Japan. It will be approved in Europe.

Refractory stage 4 colon cancer treatment by TAS-102 (Lonsurf). A medical second opinion confirms colorectal cancer diagnosis with a molecular profile of the colon cancer tumor. A medical second opinion also confirms that colon cancer cure is possible in metastatic colon cancer.

Best precision medicine treatment by TAS-102 (Lonsurf) for refractory stage 4 colon cancer with metastatic lesions. A medical second opinion helps to select a personalized medicine targeted TAS-102 (Lonsurf) treatment for stage 4 refractory colorectal cancer with liver or lung metastases.

Get a medical second opinion on advanced colorectal cancer. Be confident that your precision medicine treatment is the best. Best colorectal cancer treatment by new fluoropyrimidine pathway inhibitors TAS-102 (Lonsurf).

Dr. Anton Titov, MD: Classical colon cancer chemotherapy medications, 5-fluorouracil (5-FU) and methotrexate, have been used for over 50 years. 5-fluorouracil and methotrexate act on thymidylate synthase. This is a very important enzyme in colon cancer cell growth.

Thymidylate synthase is an enzyme that has been important historically for cancer treatment. This includes colon cancer and rectal cancer treatment. Chemotherapy medications that act on thymidylate synthase are being discovered. What are the new advanced stage 4 colon cancer treatments?

Dr. Heinz-Josef Lenz, MD: Yeah, I think it's very interesting that you bring that up. Because I think even today, 5-fluorouracil is the most effective chemotherapy medication in colon cancer. It is true even with all the new targeted medications to treat metastatic stage 4 colorectal cancer.

I think 5-fluorouracil (5-FU) will not go away. Because I think initially we were a little bit naive. We thought that new colon cancer treatment medications, new antibodies, would replace our classic cytotoxic treatments. This was as 5-fluorouracil (5-FU). But it didn't happen.

We added the new targeted chemotherapy medications onto our chemotherapeutic backbone of advanced colon cancer therapy. 5-FU is a very important pathway in cancer cell growth. 5-fluorouracil (5-FU) is a very critical pathway for the survival of normal and cancer cells.

Targeting the thymidylate synthase pathway provides a particular benefit for fast-growing cells. They are more sensitive to inhibition of thymidylate synthase. This is key for DNA synthesis.

5-FU is now being combined with either irinotecan or oxaliplatin. It is the backbone of metastatic stage 4 colon cancer chemotherapy protocols. We call these colon cancer treatment protocols FOLFIRI or FOLFOX.

But the pathway of fluoropyrimidines is very important. There is the new advanced colon cancer medication called TAS-102. TAS-102 is also targeting the fluoropyrimidine pathway. It targets this molecular cancer pathway in a slightly different method.

We know that TAS-102 (Lonsurf) inhibits this pathway. But TAS-102 can work even when 5-FU does not work anymore. TAS-102 (Lonsurf) will be approved at the end of the year in the US.

TAS-102 (Lonsurf) for advanced stage 4 colon cancer treatment is already approved in Japan. I'm sure that Europe will follow very closely with approval of TAS-102 (Lonsurf).

I think classical cytotoxic colon cancer medications were forgotten a little bit. The major focus of colon cancer therapy was on targeted treatments. But classic colon cancer treatment medications remain the most effective part of our combinations.

I think we are in need of more cytotoxic medications. Because classic chemotherapy gives us a lot of tumor shrinkage when we need it.

I think in the future treatment of colon cancer, we will select first the backbone of the chemotherapy. We will use molecular profiling of the colon cancer tumor. We will target stage 4 colon cancer treatment based on the genetic profile of the tumor.

Then we will also choose the best targeted colon cancer treatment. We will use it with a cytotoxic chemotherapy protocol. TAS-102 (Lonsurf) and 5-fluorouracil (5-FU) in advanced refractory metastatic colon cancer treatment. 5-fluorouracil and methotrexate are effective chemotherapy.