Palliative treatment of unresectable metastatic colorectal cancer.
BACKGROUND
Treatment options for metastatic colorectal cancer (mCRC) patients have rapidly increased in the past years, but 50 - 70% of mCRC patients are still unlikely to undergo radical resection of metastases and are candidates for palliative therapy only.


METHODS
Oxaliplatin and irinotecan have widened the chemotherapy alternatives available in this setting and effective targeted agents against vascular endothelial growth factor and epidermal growth factor receptor have further improved treatment efficacy. This review covers the main areas of debate in the optimal treatment of unresectable mCRC patients, focusing on the implications for everyday clinical practice and future research of the most relevant clinical trials and molecular investigations published from 1999 to 2009.


RESULTS
Insights into treatment individualization strategies are provided in the review.


CONCLUSIONS
'One size fits all' can not longer be considered an adequate approach to unresectable mCRC, and treatment with both chemotherapy and biologic agents should be guided by prognostic and predictive factors in order to maximize the benefit while reducing futile toxicities.
Fornaro
Lorenzo
L
Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Medical Oncology Unit 2, Italy.
Masi
Gianluca
G
Loupakis
Fotios
F
Vasile
Enrico
E
Falcone
Alfredo
A
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D066246:ErbB Receptors / Q000378:metabolism; D006801:Humans; D000077146:Irinotecan; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D000077150:Oxaliplatin; D010166:Palliative Care
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D066246:ErbB Receptors; D002166:Camptothecin