title: Irinotecan as palliative chemotherapy for metastatic colorectal cancer: evolving tactics following initial treatment.
abstract: BACKGROUND
  Patients with metastatic colorectal cancer (mCRC) who progress despite treatment with fluoropyrimidine and irinotecan or oxaliplatin have diminished survival, but they may derive clinically meaningful benefit from second-line or later chemotherapy.
  
  
  METHODS
  Literature from 2000 through mid-2008 on the treatment of patients with unresectable mCRC was reviewed to identify options for chemotherapy-resistant patients with mCRC.
  
  
  CONCLUSIONS
  A recurring finding is that overall survival increases when patients are exposed to all available active agents throughout their course of care, independent of the line of treatment in which medication is delivered. Sequential administration of agents, including irinotecan, oxaliplatin, bevacizumab, and cetuximab, or, alternatively, deferred administration of various medications in combination, have shown promising efficacy that is at least equivalent to established combination regimens with the same agents. Palliative chemotherapy clearly improves survival in patients with unresectable mCRC, with overall survival recently reaching 28 months.
authors.affiliation: Hépatogastroentérologie et oncologie digestive, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100, Boulogne, France. emmanuel.mitry@apr.aphp.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mitry
authors.forename: Astrid
authors.initials: A
authors.lastname: Lièvre
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Bachet
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D006801:Humans; D000077146:Irinotecan; D009362:Neoplasm Metastasis / Q000188:drug therapy*; D010166:Palliative Care
chemical_list: D000077146:Irinotecan; D002166:Camptothecin