title: Current opinion on optimal treatment for colorectal cancer.
abstract: The medical treatment of colorectal cancer (CRC) has evolved greatly in the last 10 years, involving complex combined chemotherapy protocols and, in more recent times, new biologic agents. Advances in adjuvant therapy have been limited to the addition of oxaliplatin and the substitution of oral fluoropyrimidine (e.g., capecitabine) for intravenous 5-fluorouracil with no evidence for improved outcome with biological agents. Clinical benefit from the use of the targeted monoclonal antibodies, bevacizumab, cetuximab and panitumumab, in the treatment of metastatic CRC is now well established, but the optimal timing of their use requires careful consideration to derive the maximal benefit. Evidence to date suggests potentially distinct roles for bevacizumab and EGF receptor-targeted biological agents (cetuximab and panitumumab) in the treatment of metastatic CRC. This article reviews the evidence in support of modern treatments for CRC and the decision-making behind the treatment choices, their benefits and toxicities.
authors.affiliation: The Queen Elizabeth Hospital, Adelaide Colorectal Tumour Group and University of Adelaide, Adelaide, South Australia, Australia. timothy.price@health.sa.gov.au
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
authors.forename: Eva
authors.initials: E
authors.lastname: Segelov
authors.forename: Matthew
authors.initials: M
authors.lastname: Burge
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Haller
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Ackland
authors.forename: Niall C
authors.initials: NC
authors.lastname: Tebbutt
authors.forename: Christos S
authors.initials: CS
authors.lastname: Karapetis
authors.forename: Nick
authors.initials: N
authors.lastname: Pavlakis
authors.forename: Alberto F
authors.initials: AF
authors.lastname: Sobrero
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Shapiro
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D003657:Decision Making; D006801:Humans; D058990:Molecular Targeted Therapy; D009362:Neoplasm Metastasis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal