Colorectal cancer (CRC)

Colorectal cancer (CRC) occurs when malignant (cancer) cells form in the tissues of the bowel (colon or rectum).

CRC is one of the most prevalent cancer types worldwide, with 1.8 million new cases and almost 861,000 deaths in 2018 according to the World Health Organization GLOBOCAN database. The incidence is noticeably higher in men than in women.

Colorectal cancer (CRC) occurs when malignant (cancer) cells form in the tissues of the bowel (colon or rectum). The majority of cancers occurring in the colon or rectum are adenocarcinomas, cancers that originate in glandular tissue, and account for 95% of all large bowel tumors. For most people, CRC begins as a polyp on the inner lining of the colon or rectum and grows into a tumor over the period of several years. Metastatic colorectal cancer (mCRC) occurs when the cancer has spread to another part of the body.

Most colorectal cancers do not cause any symptoms in the early stages, so they can grow 'silently' for years while the patient feels perfectly healthy. When clinical symptoms occur, the tumor is often at an advanced stage.

Some patients notice changes in their pattern of bowel movements (unexplained diarrhea or constipation). Patients may also have pain, and if the cancer is situated near the anus there may be red blood when moving the bowels. As a person loses blood over time, they will develop anemia, or lowered red blood cell count, causing them to feel tired and weak. Unexplained weight loss is another sign that a cancer may be present, but this is by no means exclusive to CRC.

The five-year survival rate of people diagnosed with stage I colorectal cancer, where the tumor is confined to the organ in which it started, is 74%. However, by stage IV, when the cancer has spread to distant sites, the five-year survival rate decreases to only six percent.

Colorectal Cancer Treatment

The survival rate of colorectal cancer patients is very dependent on the stage of the cancer being diagnosed. If diagnosed at an early stage, the life expectancy of colorectal cancer patients is quite encouraging. Even 6% of patients diagnosed at stage IV last up to 5 years.

Stadium will determine the severity, prognosis and treatment. Colorectal cancer therapy consists of curative and palliative therapy.

Colorectal cancer which already metastatic, treatment options are palliative with chemotherapy and targeted therapy.

Treatment of advanced-stage colorectal cancer with metastasis is a treatment with the concept of "Continuum Care". That is, patients are expected to be treated by a variety of therapies or drugs starting from surgery if possible, chemotherapy, up to the target therapy. All of these therapies are aimed at curbing the growth rate of cancer cells and extending the life expectancy of advanced cancer patients.

Regorafenib is the only oral treatment for colorectal cancer for advanced stages that are refractory to standard treatment and target therapy that works to inhibit several target kinases. In addition, Regorafenib allows for a single oral therapy¹.

Regorafenib has several advantages, namely as the first and only multi-kinase inhibitor that is proven to be able to control colorectal cancer² that cannot use existing standard treatments, in the form of in oral preparations with adjustable doses³, and is used as a treatment in the 3rd line⁴ and has almost three times the level of control over the disease compared to placebo⁵.

Regorafenib has the advantage of working in tumor cells where different from other therapeutic targets by inhibiting the formation of new blood vessels (angiogenesis), tumor cell growth (oncogenesis) and the formation of new tumor cells in other organs (tumor microenvironment).

^{References :
1.    Grothey Lancet/p6/Fig2/;p5/A/) (SmPC/p.13/B,C/p14/Table 5
2.    SmPC/p13/C][Grothey Lancet/p1/A]Lancet/p6/Fig2/;p5/A/] [SmPC/p13/B,C/p14/Table 5
3.    SmPC/p3/A
4.    Schmoll ESMO Guidelines 2012/p2504,2508] [NCCN Gdlns colon v2.2013/pCOL-C 1] [NCCN Gdlns rectal v3.2013/pREC-E
5.    Grothey Lancet/p5/B] [SmPC/p14/B
6.    https://pharma.bayer.com/en/treatment- care/cancer/colorectal-cancer-crc/}

^{Advice for patients : Each body reacts differently to medicines. Therefore, it is impossible to tell which medicine works best for you. Please consult your physician.}

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