title: How to select the optimal treatment for first line metastatic colorectal cancer.
abstract: Choice of first line treatment for patients with metastatic colorectal cancer (mCRC) is based on tumour and patient related factors and molecular information for determination of individual treatment aim and thus treatment intensity. Recent advances (e.g., extended RAS testing) enable tailored patient assignment to the most beneficial treatment approach. Besides fluoropyrimidines, irinotecan and oxaliplatin, a broad variety of molecular targeting agents are currently available, e.g., anti-angiogenic agents (bevacizumab) and epidermal growth factor receptor (EGFR) antibodies (cetuximab, panitumumab) for first line treatment of mCRC. Although some combinations should be avoided (e.g., oral or bolus fluoropyrimidines, oxaliplatin and EGFR antibodies), treatment options range from single agent to highly effective four-drug regimen. Preliminary data comparing EGFR antibodies and bevacizumab, both with chemotherapy, seem to favour EGFR antibodies in RAS wildtype disease. However, choosing the most appropriate treatment approach for mCRC patients remains a complex issue, with numerous open questions.
authors.affiliation: Alexander Stein, Carsten Bokemeyer, Department of Oncology, Haematology, Stem Cell Transplantation with the Section Pneumology, Hubertus Wald Tumor Centre University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stein
authors.affiliation: Alexander Stein, Carsten Bokemeyer, Department of Oncology, Haematology, Stem Cell Transplantation with the Section Pneumology, Hubertus Wald Tumor Centre University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000235:genetics; D015179:Colorectal Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D004252:DNA Mutational Analysis; D020022:Genetic Predisposition to Disease; D006801:Humans; D058990:Molecular Targeted Therapy; D009154:Mutation; D018579:Patient Selection; D010641:Phenotype; D011237:Predictive Value of Tests; D015398:Signal Transduction / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
keywords: Colorectal cancer; Epidermal growth factor receptor; Induction chemotherapy; Metastatic