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Systemic chemotherapy for nonoperable metastatic colorectal cancer: Treatment recommendations

Authors
Jeffrey W Clark, MD
Axel Grothey, MD
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

The last 10 to 15 years have seen major advances in the treatment of metastatic colorectal cancer (mCRC). In the era when fluorouracil (FU) was the sole active agent, overall survival in phase III trials was approximately 11 to 12 months. In the modern era, the average median survival duration is now approaching three years, and five-year survival rates as high as 20 percent are reported in some trials of patients treated with chemotherapy alone [1]. These improvements have been mainly driven by the availability of new active agents, which include conventional cytotoxic agents other than FU, and biologic agents targeting angiogenesis and the epidermal growth factor receptor (EGFR).

This topic review will address the practical issues that arise when choosing the appropriate treatment strategy for individual patients with inoperable mCRC. General principles of chemotherapy treatment for mCRC, data from the clinical trials that support the recommendations, recommendations for systemic chemotherapy in older adult patients with mCRC, management of patients with potentially resectable liver metastases, and a compilation of chemotherapy regimens used for advanced CRC are discussed elsewhere. (See "Systemic chemotherapy for metastatic colorectal cancer: General principles" and "Systemic chemotherapy for metastatic colorectal cancer: Completed clinical trials" and "Management of potentially resectable colorectal cancer liver metastases" and "Therapy for metastatic colorectal cancer in elderly patients and those with a poor performance status" and "Treatment protocols for small and large bowel cancer".)

OVERVIEW OF THE THERAPEUTIC APPROACH

There are now eight different classes of drugs with antitumor activity in mCRC:

Fluoropyrimidines (including fluorouracil [FU], which is usually given intravenously (IV) with leucovorin [LV], and the oral agents capecitabine, S-1, and tegafur plus uracil [UFT]).

Irinotecan.

                                                        

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 28 00:00:00 GMT+00:00 2016.
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