Second-line chemotherapy in advanced and metastatic CRC.
BACKGROUND
Chemotherapy is widely used in colorectal cancer that has relapsed or failed to respond to first-line treatment.


OBJECTIVE
To determine the efficacy of second-line chemotherapy for the treatment of advanced colorectal cancer.


METHODS
We performed electronic searches in the following databases: MEDLINE (via PubMed; 1964-September 2007), EMBASE (via OVID; 1980-September 2007) and The Cochrane Library 2007, Issue 2.


METHODS
Studies assessing the efficacy of second-line chemotherapy (single or combined treatment with any chemotherapeutic agent, at any dose and number of cycles) in patients with advanced colorectal cancer that progressed, recurred or did not respond to first-line chemotherapy.


METHODS
A descriptive analysis of the included trials was performed, due to the huge clinical heterogeneity between them.


RESULTS
Seven randomized controlled trials (RCTs) were included; one of high quality, five of moderate quality, and one conference abstract. Second-line chemotherapy (irinotecan) showed moderate benefits in overall survival and progression-free survival over Best Supportive Care (BSC) and fluorouracil (5-FU). Fractionated administration has not proven to be more beneficial and is more toxic. Definitive results concerning the benefits and risks of oxaliplatin are pending publication.


CONCLUSIONS
Second-line chemotherapy is effective in prolonging time to progression and survival in patients with advanced colorectal cancer. Further RCTs are needed to assess the optimal chemotherapy regimen.
Iberoamerican Cochrane Centre. CIBER Epidemiología y Salud Pública (CIBERESP) Spain, Hospital de la Santa Creu i Sant Pau, Casa de Convalescència, c/ Sant Antoni M. Claret 171, 4 feminine planta, Barcelona, Catalunya, Spain, 08041. mroque@santpau.es
Marta
M
Roqué I Figuls
Ivan
I
Solà
Marta
M
Martin-Richard
Juan-José
JJ
López
Xavier
X
Bonfill Cosp
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin