Second-line management of metastatic colorectal cancer.
The treatment of colorectal cancer has increased in complexity in recent years, with patients now receiving many lines of treatment. Standard first-line therapy has evolved with biologic agents used frequently in first-line settings. However, data are lacking to guide treatment decisions upon progression. Now that more is known about the toxicities of commonly used agents, such as irinotecan and oxaliplatin, stop-and-go strategies have been explored to decrease toxicities. The importance of resecting disease and decreasing tumor burden is recognized and there is some ability to get to resection even after second-line therapy. Local therapies, such as hepatic arterial infusion chemotherapy, have allowed a select group of patients to be approached with curative intent. This article reviews treatment options after progression on irinotecan- or oxaliplatin-based first-line therapy and highlights some of the difficulties encountered when interpreting data.
Gallagher
David J
DJ
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. daithig@gmail.com
Kemeny
Nancy
N
D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D018426:SEER Program; D016879:Salvage Therapy / Q000379:methods*