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Investigator Perspectives on the Current Utility of Validated and Emerging Biomarkers to Guide Treatment Decision-Making for Patients with Metastatic Colorectal.

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Presentation on theme: "Investigator Perspectives on the Current Utility of Validated and Emerging Biomarkers to Guide Treatment Decision-Making for Patients with Metastatic Colorectal."— Presentation transcript:

1 Investigator Perspectives on the Current Utility of Validated and Emerging Biomarkers to Guide Treatment Decision-Making for Patients with Metastatic Colorectal Cancer: Personalized Selection of Systemic Therapy N = 26 Completed Surveys

2 Co-Chairs Survey Participants Tanios Bekaii-Saab, MD Alan P Venook, MD
Professor Dirk Arnold, MD, PhD Heinz-Josef Lenz, MD Johanna Bendell, MD Christopher Lieu, MD Al B Benson III, MD John L Marshall, MD Jordan D Berlin, MD Wells A Messersmith, MD Kristen Ciombor, MD, MSCI Jeffrey A Meyerhardt, MD, MPH Steven J Cohen, MD Michael A Morse, MD, MHS Aimery de Gramont, MD Bert H O'Neil, MD Cathy Eng, MD Michael J Overman, MD Richard M Goldberg, MD Philip A Philip, MD, PhD J Randolph Hecht, MD Eric Van Cutsem, MD, PhD Howard S Hochster, MD Zev Wainberg, MD, MSc Scott Kopetz, MD, PhD Christina Wu, MD N = 26 investigators

3 Indications for and Practical Implementation of Biomarker Analysis for Patients with Metastatic Colorectal Cancer (mCRC)

4 In general, what type of tumor assays, if any, do you order for your patients with mCRC?
25 Pan-RAS (KRAS/NRAS) 25 BRAF 25 MSI status 24 HER2 PIK3CA 8 NGS panel 5 KRAS 2 NRAS 2 NTRK 1 N = 26 clinical investigators

5 What type of tumor assays, if any, do you believe oncologists in community practice should be ordering for these individuals? 26 Pan-RAS (KRAS/NRAS) 26 MSI status 25 BRAF 17 HER2 KRAS 2 NRAS 2 PIK3CA 2 NTRK 2 BRCA 1 N = 26 clinical investigators

6 Do you believe there is any current role for rebiopsy/repeat biomarker assessment in patients with progressive mCRC? Yes 16 No 10 N = 26 clinical investigators

7 Biology of mCRC and Role of Tumor Sidedness in First- and Later-Line Decision-Making

8 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 9 FOLFOX/CAPOX + bevacizumab 5 FOLFOX/CAPOX + cetuximab 4 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + panitumumab 3 FOLFIRI/CAPIRI + cetuximab 2 FOLFIRI/CAPIRI + panitumumab 1 1 FOLFIRI/CAPIRI Capecitabine + bevacizumab 1 N = 26 clinical investigators

9 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 5 FOLFOX/CAPOX + panitumumab 5 FOLFOXIRI + bevacizumab 4 FOLFOX/CAPOX + cetuximab 3 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + panitumumab 2 FOLFIRI/CAPIRI + cetuximab 2 FOLFOXIRI + panitumumab 1 FOLFOXIRI + cetuximab  1 FOLFIRINOX + cetuximab 1 FOLFOXIRI N = 26 clinical investigators

10 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 18 FOLFOX/CAPOX + bevacizumab 5 FOLFIRI/CAPIRI + bevacizumab FOLFIRI/CAPIRI 1 Capecitabine + bevacizumab 1 N = 25 clinical investigators

11 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type FOLFOXIRI + bevacizumab 13 6 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 3 FOLFOXIRI 1 FOLFIRINOX + bevacizumab 1 N = 24 clinical investigators

12 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 10 FOLFOX/CAPOX + bevacizumab 5 Capecitabine + bevacizumab 3 FOLFOX/CAPOX + cetuximab FOLFOX/CAPOX 2 2 5-FU/LV + cetuximab 1 FOLFIRI/CAPIRI 1 FOLFIRI/CAPIRI + bevacizumab 1 FOLFIRI/CAPIRI + panitumumab 1 5-FU/LV + bevacizumab N = 26 clinical investigators

13 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 9 FOLFOX/CAPOX + bevacizumab 5 FOLFOX/CAPOX + cetuximab 4 FOLFOX/CAPOX + panitumumab FOLFIRI/CAPIRI + bevacizumab 3 FOLFOX/CAPOX 2 FOLFIRI/CAPIRI + panitumumab 1 1 FOLFOXIRI FOLFIRI/CAPIRI + cetuximab 1 N = 26 clinical investigators

14 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type FOLFOX/CAPOX + bevacizumab 14 5 Capecitabine + bevacizumab 5-FU/LV + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 2 FOLFOX/CAPOX 1 FOLFIRI/CAPIRI 1 N = 26 clinical investigators

15 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 19 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 4 FOLFOXIRI + bevacizumab 2 FOLFOX/CAPOX 1 N = 26 clinical investigators

16 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 11 FOLFIRI/CAPIRI + bevacizumab 5 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + panitumumab FOLFOX/CAPOX + panitumumab 2 Irinotecan + cetuximab 2 1 FOLFIRI/CAPIRI + panitumumab 1 FOLFOX/CAPOX 1 FOLFIRI/CAPIRI + cetuximab  N = 26 clinical investigators

17 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 6 FOLFIRI/CAPIRI + panitumumab 5 FOLFIRI/CAPIRI + bevacizumab 4 Irinotecan + panitumumab 4 FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 2 FOLFIRI/CAPIRI + cetuximab 1 FOLFOX/CAPOX 1 FOLFOX/CAPOX + panitumumab 1 FOLFOXIRI + panitumumab N = 26 clinical investigators

18 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 15 FOLFIRI/CAPIRI + bevacizumab 5 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + EGFR antibody 5-FU/LV + bevacizumab 1 FOLFOX/CAPOX 1 Irinotecan + cetuximab 1 1 Irinotecan + bevacizumab N = 26 clinical investigators

19 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 13 FOLFIRI/CAPIRI + bevacizumab 3 Irinotecan + panitumumab 2 FOLFIRI/CAPIRI + panitumumab 2 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + cetuximab 1 5-FU/LV + bevacizumab 1 FOLFOXIRI + bevacizumab 1 Irinotecan + cetuximab 1 Panitumumab 1 FOLFIRI + aflibercept N = 26 clinical investigators

20 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 9 FOLFIRI/CAPIRI + bevacizumab 4 Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + panitumumab 2 Irinotecan + bevacizumab FOLFIRI/CAPIRI + panitumumab 1 1 FOLFOX/CAPOX 1 FOLFOX/CAPOX + panitumumab 1 Panitumumab 1 FOLFIRI/CAPIRI + cetuximab N = 26 clinical investigators

21 Symptom burden: Requires response Tumor location: Left side
Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on your first-line treatment of the choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 8 FOLFIRI/CAPIRI + bevacizumab 4 Irinotecan + cetuximab 3 Irinotecan + panitumumab 2 FOLFOX/CAPOX 2 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + panitumumab 1 FOLFOX/CAPOX + panitumumab 1 FOLFIRI/CAPIRI + cetuximab 1 FOLFOXIRI + panitumumab 1 Panitumumab 1 FOLFIRI N = 26 clinical investigators

22 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 12 FOLFIRI/CAPIRI + bevacizumab 5 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + bevacizumab Irinotecan + cetuximab 2 Irinotecan 2 FOLFOX/CAPOX 1 1 FOLFIRI/CAPIRI + panitumumab N = 26 clinical investigators

23 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 15 FOLFIRI/CAPIRI + bevacizumab 4 FOLFOX/CAPOX + bevacizumab Irinotecan + cetuximab 2 FOLFOX/CAPOX 1 FOLFIRI/CAPIRI + panitumumab 1 FOLFIRI/CAPIRI + cetuximab 1 1 Irinotecan + panitumumab FOLFIRI 1 N = 26 clinical investigators

24 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 8 Regorafenib 7 TAS-102 5 Irinotecan + panitumumab Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 1 Panitumumab 1 1 Cetuximab N = 26 clinical investigators

25 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 8 TAS-102 5 Irinotecan + panitumumab 5 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 2 1 FOLFIRI/CAPIRI + panitumumab 1 Cetuximab N = 24 clinical investigators

26 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 8 TAS-102 7 Regorafenib 5 Irinotecan + panitumumab Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 1 Panitumumab 1 N = 25 clinical investigators

27 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 9 TAS-102 4 Irinotecan + panitumumab 4 Regorafenib Irinotecan + cetuximab 3 2 FOLFOX/CAPOX + bevacizumab 1 FOLFIRI/CAPIRI + panitumumab 1 Cetuximab N = 24 clinical investigators

28 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS wild type 11 TAS-102 6 Regorafenib 4 Irinotecan + panitumumab Irinotecan + cetuximab 2 2 Panitumumab 1 FOLFOX/CAPOX + bevacizumab N = 26 clinical investigators

29 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS wild type 9 TAS-102 5 Irinotecan + panitumumab 5 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 2 FOLFIRI/CAPIRI + panitumumab 1 1 Panitumumab Cetuximab 1 N = 26 clinical investigators

30 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS wild type 11 TAS-102 5 Regorafenib 4 Irinotecan + panitumumab Irinotecan + cetuximab 3 2 Panitumumab 1 FOLFOX/CAPOX + bevacizumab N = 26 clinical investigators

31 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS wild type 11 TAS-102 4 Regorafenib 4 Irinotecan + panitumumab Irinotecan + cetuximab 3 FOLFOX/CAPOX + bevacizumab 2 FOLFIRI/CAPIRI + panitumumab 1 1 Panitumumab N = 26 clinical investigators

32 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 19 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 5 FOLFIRI/CAPIRI 1 Capecitabine + bevacizumab 1 N = 26 clinical investigators

33 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation 12 FOLFOXIRI + bevacizumab 9 FOLFOX/CAPOX + bevacizumab 2 FOLFOXIRI 2 FOLFIRI/CAPIRI + bevacizumab FOLFIRINOX + bevacizumab 1 N = 26 clinical investigators

34 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 19 FOLFOX/CAPOX + bevacizumab FOLFIRI/CAPIRI + bevacizumab 5 FOLFIRI/CAPIRI 1 Capecitabine + bevacizumab 1 N = 26 clinical investigators

35 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Right Biomarker status: RAS mutation 13 FOLFOXIRI + bevacizumab 8 FOLFOX/CAPOX + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI 1 1 FOLFIRINOX + bevacizumab N = 26 clinical investigators

36 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 12 FOLFOX/CAPOX + bevacizumab 5 Capecitabine + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 5-FU/LV + bevacizumab 3 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 1 FOLFIRI/CAPIRI N = 26 clinical investigators

37 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation FOLFOX/CAPOX + bevacizumab 18 FOLFIRI/CAPIRI + bevacizumab 3 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 1 FOLFOXIRI FOLFOXIRI + bevacizumab 1 5-FU/LV + bevacizumab 1 N = 26 clinical investigators

38 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 13 FOLFOX/CAPOX + bevacizumab 5 Capecitabine + bevacizumab 3 5-FU/LV + bevacizumab FOLFIRI/CAPIRI + bevacizumab 2 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 1 FOLFIRI/CAPIRI N = 26 clinical investigators

39 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Right Biomarker status: RAS mutation FOLFOX/CAPOX + bevacizumab 18 4 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI + bevacizumab 2 FOLFOX/CAPOX 1 FOLFOX/CAPOX + cetuximab 1 N = 26 clinical investigators

40 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation FOLFIRI/CAPIRI + bevacizumab 17 4 FOLFOX/CAPOX + bevacizumab FOLFOX/CAPOX 2 Irinotecan + cetuximab 2 FOLFIRI + aflibercept 1 N = 26 clinical investigators

41 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation 15 FOLFIRI/CAPIRI + bevacizumab 3 FOLFOX/CAPOX + bevacizumab 3 TAS-102 2 FOLFIRI + aflibercept 1 FOLFOX/CAPOX 1 FOLFOXIRI + bevacizumab 1 Irinotecan + cetuximab N = 26 clinical investigators

42 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 17 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 4 1 5-FU/LV + bevacizumab FOLFOX/CAPOX 1 Irinotecan + cetuximab 1 Irinotecan + bevacizumab 1 1 FOLFIRI + aflibercept N = 26 clinical investigators

43 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation 17 FOLFIRI/CAPIRI + bevacizumab 3 TAS-102 2 FOLFOX/CAPOX + bevacizumab 5-FU/LV + bevacizumab 1 FOLFOXIRI + bevacizumab 1 Irinotecan + cetuximab 1 1 FOLFIRI + aflibercept N = 26 clinical investigators

44 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 15 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 4 2 FOLFOX/CAPOX Irinotecan 2 Irinotecan + bevacizumab 2 Irinotecan + cetuximab 1 N = 26 clinical investigators

45 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation FOLFIRI/CAPIRI + bevacizumab 17 3 FOLFOX/CAPOX + bevacizumab FOLFOX/CAPOX 2 Irinotecan + cetuximab 1 Irinotecan 1 FOLFIRI   1 1 FOLFIRI + aflibercept  N = 26 clinical investigators

46 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 14 FOLFIRI/CAPIRI + bevacizumab 6 FOLFOX/CAPOX + bevacizumab 3 Irinotecan + bevacizumab Irinotecan + cetuximab 1 Irinotecan 1 FOLFOX/CAPOX 1 N = 26 clinical investigators

47 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation 17 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 4 1 FOLFOX/CAPOX Irinotecan + cetuximab 1 Irinotecan 1 FOLFIRI 1 1 FOLFIRI + aflibercept N = 26 clinical investigators

48 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation 15 TAS-102 Regorafenib 9 1 Irinotecan + cetuximab N = 25 clinical investigators

49 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation 13 TAS-102 8 Regorafenib 1 FOLFOX/CAPOX + bevacizumab Irinotecan + cetuximab 1 1 Irinotecan + panitumumab N = 24 clinical investigators

50 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation 15 TAS-102 9 Regorafenib 1 Irinotecan + cetuximab N = 25 clinical investigators

51 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation 14 TAS-102 8 Regorafenib 1 FOLFOX/CAPOX + bevacizumab Irinotecan + cetuximab 1 N = 24 clinical investigators

52 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: RAS mutation TAS-102 18 6 Regorafenib FOLFOX/CAPOX + bevacizumab 1 Irinotecan + cetuximab 1 N = 26 clinical investigators

53 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: RAS mutation TAS-102 17 6 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 1 N = 26 clinical investigators

54 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: RAS mutation TAS-102 18 6 Regorafenib FOLFOX/CAPOX + bevacizumab 1 Irinotecan + cetuximab 1 N = 26 clinical investigators

55 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: RAS mutation TAS-102 17 6 Regorafenib FOLFOX/CAPOX + bevacizumab 2 Irinotecan + cetuximab 1 N = 26 clinical investigators

56 Current and Future Treatment Options for Patients with BRAF Mutations

57 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOXIRI + bevacizumab 8 FOLFOX/CAPOX + bevacizumab 1 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI 1 Encorafenib + binimetinib + cetuximab 1 FOLFIRINOX + bevacizumab 1 N = 26 clinical investigators

58 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Biomarker status: BRAF V600E mutation (RAS wild type) Tumor location: Left side 17 FOLFOXIRI + bevacizumab 3 FOLFOX/CAPOX + bevacizumab 2 FOLFOXIRI FOLFIRI/CAPIRI + bevacizumab 1 Encorafenib + binimetinib + cetuximab 1 FOLFIRINOX + bevacizumab 1 1 FOLFIRINOX N = 26 clinical investigators

59 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOXIRI + bevacizumab FOLFOX/CAPOX + bevacizumab 8 FOLFIRI/CAPIRI + bevacizumab 1 FOLFOXIRI 1 Encorafenib + binimetinib + cetuximab 1 1 FOLFIRINOX + bevacizumab N = 26 clinical investigators

60 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) FOLFOXIRI + bevacizumab 18 2 FOLFOX/CAPOX + bevacizumab FOLFOXIRI 2 Encorafenib + binimetinib + cetuximab 2 FOLFIRINOX + bevacizumab 1 FOLFIRINOX 1 N = 26 clinical investigators

61 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 2 2 FOLFOXIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 5-FU/LV + bevacizumab Capecitabine + bevacizumab 1 N = 26 clinical investigators

62 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFOXIRI + bevacizumab 3 2 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 FOLFIRINOX N = 26 clinical investigators

63 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 2 2 FOLFOXIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 5-FU/LV + bevacizumab Capecitabine + bevacizumab 1 N = 26 clinical investigators

64 Regulatory and reimbursement issues aside, what is your preferred first-line systemic treatment choice outside of a clinical trial for this patient with newly diagnosed mCRC? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 14 FOLFOX/CAPOX + bevacizumab 4 Encorafenib + binimetinib + cetuximab FOLFOXIRI + bevacizumab 3 2 FOLFIRI/CAPIRI + bevacizumab FOLFOX/CAPOX 1 FOLFOXIRI 1 1 FOLFIRINOX N = 26 clinical investigators

65 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 7 Encorafenib + binimetinib + cetuximab 6 FOLFIRI/CAPIRI + bevacizumab Irinotecan + cetuximab + vemurafenib 5 3 Irinotecan + panitumumab + vemurafenib FOLFOX/CAPOX + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 1 FOLFOXIRI + bevacizumab 1 Encorafenib + binimetinib + panitumumab 1 Irinotecan N = 26 clinical investigators

66 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) Encorafenib + binimetinib + cetuximab 9 Irinotecan + cetuximab + vemurafenib 7 3 FOLFIRI/CAPIRI + bevacizumab 3 Irinotecan + panitumumab + vemurafenib FOLFOXIRI + bevacizumab 2 Encorafenib + binimetinib + panitumumab 1 1 Dabrafenib + trametinib + panitumumab N = 26 clinical investigators

67 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 7 Encorafenib + binimetinib + cetuximab 6 FOLFIRI/CAPIRI + bevacizumab Irinotecan + cetuximab + vemurafenib 5 Irinotecan + panitumumab + vemurafenib 3 FOLFOX/CAPOX + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 1 FOLFOXIRI + bevacizumab 1 Encorafenib + binimetinib + panitumumab 1 Irinotecan N = 26 clinical investigators

68 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 9 Encorafenib + binimetinib + cetuximab 7 Irinotecan + cetuximab + vemurafenib FOLFIRI/CAPIRI + bevacizumab 3 3 Irinotecan + panitumumab + vemurafenib FOLFOXIRI + bevacizumab 2 Dabrafenib + trametinib + panitumumab 1 Encorafenib + binimetinib + panitumumab 1 N = 26 clinical investigators

69 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 6 FOLFIRI/CAPIRI + bevacizumab 4 Encorafenib + binimetinib + cetuximab 4 Irinotecan + cetuximab + vemurafenib 3 FOLFOX/CAPOX + bevacizumab Irinotecan + panitumumab + vemurafenib 3 2 Irinotecan FOLFOXIRI + bevacizumab 1 1 Dabrafenib + trametinib + panitumumab Capecitabine + bevacizumab 1 N = 25 clinical investigators

70 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 7 Encorafenib + binimetinib + cetuximab Irinotecan + cetuximab + vemurafenib 6 3 FOLFOX/CAPOX + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 2 Irinotecan + panitumumab + vemurafenib 1 FOLFOXIRI + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 Irinotecan + bevacizumab Capecitabine + bevacizumab 1 N = 25 clinical investigators

71 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) FOLFIRI/CAPIRI + bevacizumab 6 Encorafenib + binimetinib + cetuximab 4 Irinotecan + cetuximab + vemurafenib 4 FOLFOX/CAPOX + bevacizumab 3 3 Irinotecan + panitumumab + vemurafenib Irinotecan 2 FOLFOXIRI + bevacizumab 1 1 Dabrafenib + trametinib + panitumumab Capecitabine + bevacizumab 1 N = 25 clinical investigators

72 Regulatory and reimbursement issues aside, what is your preferred second-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first-line treatment of your choice? Age: 80 Symptom burden: Requires response Biomarker status: BRAF V600E mutation Tumor location: Right side (RAS wild type) Encorafenib + binimetinib + cetuximab 7 Irinotecan + cetuximab + vemurafenib 6 FOLFOX/CAPOX + bevacizumab 3 FOLFIRI/CAPIRI + bevacizumab 3 2 Irinotecan + panitumumab + vemurafenib FOLFOXIRI + bevacizumab 1 Dabrafenib + trametinib + panitumumab 1 1 Irinotecan + bevacizumab Capecitabine + bevacizumab 1 N = 25 clinical investigators

73 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 Regorafenib 5 4 Encorafenib + binimetinib + cetuximab Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 N = 24 clinical investigators

74 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 Regorafenib 4 Irinotecan + cetuximab + vemurafenib 3 2 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 1 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 Dabrafenib + trametinib + panitumumab   1 N = 24 clinical investigators

75 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 5 Regorafenib Encorafenib + binimetinib + cetuximab 4 Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 N = 24 clinical investigators

76 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 60 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 11 TAS-102 4 Regorafenib Irinotecan + cetuximab + vemurafenib 3 2 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 1 Irinotecan + cetuximab 1 Irinotecan + panitumumab + vemurafenib 1 Dabrafenib + trametinib + panitumumab   1 N = 24 clinical investigators

77 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 12 TAS-102 4 Regorafenib Encorafenib + binimetinib + cetuximab 3 3 Supportive care Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 1 Irinotecan + panitumumab + vemurafenib N = 26 clinical investigators

78 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Left side Biomarker status: BRAF V600E mutation (RAS wild type) 13 TAS-102 3 Irinotecan + cetuximab + vemurafenib 3 Supportive care 3 Regorafenib 1 Encorafenib + binimetinib + cetuximab FOLFIRI/CAPIRI + bevacizumab 1 1 Irinotecan + cetuximab Irinotecan + panitumumab + vemurafenib 1 N = 26 clinical investigators

79 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Clinically stable Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 12 TAS-102 4 Regorafenib Encorafenib + binimetinib + cetuximab 3 3 Supportive care Irinotecan + cetuximab + vemurafenib 2 Irinotecan + cetuximab 1 1 Irinotecan + panitumumab + vemurafenib N = 26 clinical investigators

80 Regulatory and reimbursement issues aside, what is your preferred third-line systemic treatment choice outside of a clinical trial for this patient with mCRC who has received and experienced disease progression on the first- and second-line treatments of your choice? Age: 80 Symptom burden: Requires response Tumor location: Right side Biomarker status: BRAF V600E mutation (RAS wild type) 13 TAS-102 3 Irinotecan + cetuximab + vemurafenib Supportive care 3 Regorafenib 3 Encorafenib + binimetinib + cetuximab 1 FOLFIRI/CAPIRI + bevacizumab 1 1 Irinotecan + cetuximab Irinotecan + panitumumab + vemurafenib 1 N = 26 clinical investigators

81 Do you typically administer BRAF-targeted therapy for your patients with mCRC with BRAF V600E mutations? 24 Yes No 2 N = 26 clinical investigators

82 Optimal Management of Microsatellite Instability (MSI) High or DNA Mismatch Repair Deficient (dMMR) mCRC

83 First line Second line Third line or beyond
Reimbursement and regulatory issues aside, for a patient with MSI-high mCRC, in what line of therapy would you generally administer an anti-PD-1/ PD-L1 antibody? 7 First line 14 Second line Third line or beyond 5 N = 26 clinical investigators

84 Which of the following checkpoint inhibitors have you administered to a patient with MSI-high mCRC? (Select all that apply.) 23 Pembrolizumab 19 Nivolumab 16 Nivolumab/ ipilimumab Atezolizumab 5 Durvalumab 1 N = 26 clinical investigators

85 What is your usual first-line treatment recommendation for a 60-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC? 12 FOLFOX/CAPOX + bevacizumab 5 FOLFOX/CAPOX + EGFR antibody Nivolumab/ipilimumab 3 2 FOLFIRI/CAPIRI + bevacizumab FOLFOXIRI 1 Pembrolizumab 1 1 FOLFIRI/CAPIRI + EGFR antibody N = 25 clinical investigators

86 What is your usual first-line treatment recommendation for an 80-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC? FOLFOX/CAPOX + bevacizumab 7 6 Pembrolizumab FOLFOX/CAPOX + EGFR antibody 3 3 Nivolumab/ipilimumab 3 Nivolumab 2 FOLFIRI/CAPIRI 1 FOLFOX/CAPOX Pembrolizumab or nivolumab (“coin flip”) 1 N = 26 clinical investigators

87 What is your usual second-line treatment recommendation for a 60-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who responds to first-line FOLFOX/bevacizumab and experiences disease progression after receiving 9 months of bevacizumab maintenance? 11 Pembrolizumab 8 Nivolumab/ipilimumab FOLFIRI/CAPIRI + bevacizumab 4 2 Pembrolizumab or nivolumab (“coin flip”) Nivolumab 1 N = 26 clinical investigators

88 What is your usual second-line treatment recommendation for an 80-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who responds to first-line FOLFOX/bevacizumab and experiences disease progression after receiving 9 months of bevacizumab maintenance? 14 Pembrolizumab 4 Pembrolizumab or nivolumab (“coin flip”) Nivolumab/ipilimumab 3 3 Nivolumab FOLFIRI/CAPIRI + bevacizumab 2 N = 26 clinical investigators

89 What is your usual third-line treatment recommendation for a 60-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who receives first-line FOLFOX/bevacizumab and second-line FOLFIRI/bevacizumab and is now experiencing disease progression? 13 Nivolumab/ipilimumab 9 Pembrolizumab Nivolumab 3 Pembrolizumab or nivolumab/ipilimumab (“coin flip”) 1 N = 26 clinical investigators

90 What is your usual third-line treatment recommendation for an 80-year-old patient with left-sided, pan-RAS wild-type, MSI-high mCRC who receives first-line FOLFOX/bevacizumab and second-line FOLFIRI/bevacizumab and is now experiencing disease progression? 13 Pembrolizumab 4 Pembrolizumab or nivolumab (“coin flip”) Nivolumab/ipilimumab 4 4 Nivolumab FOLFIRI/CAPIRI + EGFR antibody 1 N = 26 clinical investigators

91 HER2 Positivity and Other Potential Biomarkers

92 Reimbursement and regulatory issues aside, for a patient with mCRC with HER2 mutation/amplification, in what line of therapy would you generally administer anti-HER2 therapy? 3 First line 11 Second line Third line or beyond 11 1 I would not administer anti-HER2 therapy N = 26 clinical investigators

93 For a patient with mCRC with HER2 mutation/amplification to whom you would administer anti-HER2 therapy, which regimen would you recommend? 11 Trastuzumab/pertuzumab 9 Trastuzumab/lapatinib Trastuzumab 5 N = 25 clinical investigators


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