title: Which strategy after first-line therapy in advanced colorectal cancer?
abstract: Second-line therapy for advanced colorectal cancer is an integral part of the treatment strategy that needs to be set from the beginning for each patient, bearing in mind the expected toxicities of chosen treatments, the patient's clinical condition, comorbidities, preferences, the aims of the treatment and the molecular status. Furthermore, the distinction between lines of therapy is no longer absolute. The perspective of "continuum of care" includes switching chemotherapy prior to disease progression, maintenance therapy, drug "holidays" if needed, surgical resection of metastases in selected patients, and seems to allow a tailored treatment, in which patients are more likely to benefit from exposure to all active agents, which is known to correlate with overall survival. The scenario of second-line treatment has changed dramatically over the years and could currently benefit from several options including chemotherapy with a single agent or in combination and the addition of molecular-targeted agents developed in the last decade, such as epidermal growth factor receptor antibodies (cetuximab, panitumumab) and vascular endothelial growth factor-targeting agents (bevacizumab, aflibercept), with the possibility of bevacizumab use even beyond first progression. The purpose of this review is to summarize the most important scientific data supporting the use of chemotherapy and the new biologic agents in the second-line setting in advanced colorectal cancer.
authors.affiliation: Coinu Andrea, Petrelli Fausto, Borgonovo Karen Francesca, Cabiddu Mary, Ghilardi Mara, Lonati Veronica, Barni Sandro, Medical Oncology Unit, Oncology Department, Azienda Ospedaliera di Treviglio, Treviglio, 24047 BG, Italy.
authors.forename: Coinu
authors.initials: C
authors.lastname: Andrea
authors.affiliation: Coinu Andrea, Petrelli Fausto, Borgonovo Karen Francesca, Cabiddu Mary, Ghilardi Mara, Lonati Veronica, Barni Sandro, Medical Oncology Unit, Oncology Department, Azienda Ospedaliera di Treviglio, Treviglio, 24047 BG, Italy.
authors.forename: Petrelli
authors.initials: P
authors.lastname: Fausto
authors.affiliation: Coinu Andrea, Petrelli Fausto, Borgonovo Karen Francesca, Cabiddu Mary, Ghilardi Mara, Lonati Veronica, Barni Sandro, Medical Oncology Unit, Oncology Department, Azienda Ospedaliera di Treviglio, Treviglio, 24047 BG, Italy.
authors.forename: Borgonovo Karen
authors.initials: BK
authors.lastname: Francesca
authors.affiliation: Coinu Andrea, Petrelli Fausto, Borgonovo Karen Francesca, Cabiddu Mary, Ghilardi Mara, Lonati Veronica, Barni Sandro, Medical Oncology Unit, Oncology Department, Azienda Ospedaliera di Treviglio, Treviglio, 24047 BG, Italy.
authors.forename: Cabiddu
authors.initials: C
authors.lastname: Mary
authors.affiliation: Coinu Andrea, Petrelli Fausto, Borgonovo Karen Francesca, Cabiddu Mary, Ghilardi Mara, Lonati Veronica, Barni Sandro, Medical Oncology Unit, Oncology Department, Azienda Ospedaliera di Treviglio, Treviglio, 24047 BG, Italy.
authors.forename: Ghilardi
authors.initials: G
authors.lastname: Mara
authors.affiliation: Coinu Andrea, Petrelli Fausto, Borgonovo Karen Francesca, Cabiddu Mary, Ghilardi Mara, Lonati Veronica, Barni Sandro, Medical Oncology Unit, Oncology Department, Azienda Ospedaliera di Treviglio, Treviglio, 24047 BG, Italy.
authors.forename: Lonati
authors.initials: L
authors.lastname: Veronica
authors.affiliation: Coinu Andrea, Petrelli Fausto, Borgonovo Karen Francesca, Cabiddu Mary, Ghilardi Mara, Lonati Veronica, Barni Sandro, Medical Oncology Unit, Oncology Department, Azienda Ospedaliera di Treviglio, Treviglio, 24047 BG, Italy.
authors.forename: Barni
authors.initials: B
authors.lastname: Sandro
mesh_terms: D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D057915:Drug Substitution; D006801:Humans; D058990:Molecular Targeted Therapy; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D017211:Treatment Failure
keywords: Advanced colorectal cancer; Overall survival; Polychemotherapy; Second-line; Targeted agents
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