Therapeutic advances in the management of metastatic colorectal cancer.
Metastatic colorectal cancer has long been considered as a short-term, poor prognosis, chemoresistant disease. Until the early 1990s, the impact of systemic chemotherapy on patient outcome was debated. Recently, the emergence of new therapeutic modalities (5-FU modulations and associations with oxaliplatin and irinotecan) has led to a significant improvement in tumor response rates and patient survival. Thus, the indications of curative surgery of visceral metastases, frequently preceded and followed by chemotherapy, systemic or intra-arterial or both, have become more frequent. In this paper we will review and comment on the results of the major clinical trials published in the past 5 years and propose some decision strategies regarding the main clinical situations met in daily practice.
Freyer
G
G
Medical Oncology Unit, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite, France. Gilles.Freyer@chu-lyon.fr
Ligneau
B
B
Kraft
D
D
Descos
L
L
Trillet-Lenoir
V
V
D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D004359:Drug Therapy, Combination; D005472:Fluorouracil / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D007261:Infusions, Intra-Arterial; D000077146:Irinotecan; D002955:Leucovorin / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D009362:Neoplasm Metastasis / Q000188:drug therapy* / Q000473:pathology; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin; D008727:Methotrexate