Introduction: Advances in treatment of metastatic colorectal cancer

Abstract

Despite advances in screening and treatment, colorectal cancer remains one of the most common malignant diseases in Europe and Northern America, with high mortality and difficult though varied and changing management challenges. Many patients have metastatic disease at the time of diagnosis or develop metastases, often involving the liver, after resection. In the past, in patients who were deemed unresectable, long-term survival was rare. With the limited efficacy of bolus or infusional fluorouracil modulated by leucovorin the major options for treatment of advanced colorectal cancer until relatively recently median overall survival was only 11.5 months. 1 Unavoidably, palliative symptom control became the focus of management early in the course of disease. The introduction of cytotoxic medications such as oxaliplatin and irinotecan, monoclonal antibodies such as bevacizumab and cetuximab, and their incorporation into fluorouracil-based first-line and salvage regimens has led to improved response rates and a prolonged duration of survival that currently exceeds two years, while surgical intervention in selected patients responding to preor peri-operative chemotherapy yields durations of survival that are considerably longer. 2 12 Data consistently support strategies making all effective agents available to patients during the course of their treatment. 13,14 With this increased number and range of treatment possibilities, however, important questions are now emerging regarding the best method of treatment selection as well as the employment of agents as monotherapy, in combination, and in what sequence. The requirement for multidisciplinary cooperation becomes evident.