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	Editor’s Note
	Candor with Humility

A couple of years ago at ASCO, a community-based medical oncologist sitting next to me at a presentation commented, “Research leaders say one thing when they are on the podium, but I wonder what they really do with their own patients. ” Since that time, I have frequently asked researchers interviewed for our programs to present patients from their own practice. The results of these presentations have been fascinating.

In this program, Mace Rothenberg discusses a patient who sought his care because she wanted to be treated on a research protocol that included an anti-angiogenic agent. The patient, however, was too ill to meet the protocol entry criteria. After much discussion, the woman reluctantly agreed to take capecitabine and had an excellent response with minimal toxicity. Dr Rothenberg presented this case to a “consensus panel” and most of the respondents stated that they would have used multi-agent therapy. Dr Rothenberg believes that type of aggressive strategy would have been very risky in this patient with a poor performance status.

Additionally, James Cassidy presents a man in his 20s who had an excellent response to FOLFOX-4 (oxaliplatin/5-FU/leucovorin) followed by a two-staged complete hepatectomy. This was, in fact, the first time Dr Cassidy had ever employed this strategy, and at each step in this patient’s complicated course, he and the patient agonized over how to proceed. Currently this man is not receiving active traditional therapy but is pursuing alternative medicine approaches. These two cases are examples of the pitfalls of employing a “one-size-fits-all” approach to the treatment of patients with colorectal cancer. Research leaders interviewed for this series have repeatedly commented that the recent introduction of oxaliplatin, irinotecan and capecitabine have dramatically altered the therapeutic landscape and have thus made patients with courses like those of Drs Rothenberg and Cassidy much more common.

Ultimately, it seems likely that the greatest potential impact of these new agents and regimens will be in the adjuvant setting. Combined with the more widespread use of screening modalities like colonoscopy, these new additions to our armamentarium offer the possibility of a major step forward in colorectal cancer control.

— Neil Love, MD