title: Evidence-based appraisal of the upfront treatment for unresectable metastatic colorectal cancer patients.
abstract: Colorectal cancer (CRC) is a significant health problem, with around 1 million new cases and 500000 deaths every year worldwide. Over the last two decades, the use of novel therapies and more complex treatment strategies have contributed to progressively increase the median survival of patients with unresectable advanced CRC up to approximately 30 mo. The availability of additional therapeutic options, however, has created new challenges and generated more complicated treatment algorithms. Moreover, several clinically important points are still in debate in first-line, such as the optimal treatment intensity, the most appropriate maintenance strategy, the preferred biologic to be used upfront in patients with KRAS wild-type CRC, and the need for more detailed information on tumor biology. In this moving landscape, this review analyses why the first-line treatment decision is crucial and how the choice may impact on further treatment lines. In addition, it focuses on results of major phase III randomized trials.
authors.affiliation: Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.affiliation: Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
authors.forename: Stefania Eufemia
authors.initials: SE
authors.lastname: Lutrino
authors.affiliation: Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ferrari
authors.affiliation: Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
authors.forename: Mariaelena
authors.initials: M
authors.lastname: Casagrande
authors.affiliation: Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Bonotto
authors.affiliation: Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Ongaro
authors.affiliation: Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Puglisi
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D019317:Evidence-Based Medicine; D020022:Genetic Predisposition to Disease; D006801:Humans; D058990:Molecular Targeted Therapy; D009154:Mutation; D018579:Patient Selection; D010641:Phenotype; D057285:Precision Medicine; D011237:Predictive Value of Tests; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D016896:Treatment Outcome; D018631:ras Proteins / Q000235:genetics
chemical_list: D020533:Angiogenesis Inhibitors; C117307:KRAS protein, human; D047428:Protein Kinase Inhibitors; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins
keywords: Angiogenic inhibitors; Chemotherapy; Colorectal cancer; Epidermal growth factor receptor inhibitors; First-line; Maintenance