title: Current controversies in the management of metastatic colorectal cancer.
abstract: The factors affecting the decisions for the treatment for patients with metastatic colorectal cancer (mCRC) are related to the patient, the tumor, and the treatment itself. Both cetuximab and panitumumab are anti-EGFR monoclonal antibody options for patients with RAS wild-type tumors. Several trials comparing these agents with bevacizumab are analyzed in this paper. The liver is the most common site of metastases in patients with CRC, and perioperative chemotherapy has been shown to yield benefits in this setting. In the second-line treatment for mCRC, maintenance with bevacizumab after progression following first-line treatment is convenient in some groups of patients with mCRC. Also, aflibercept has demonstrated benefits in response rate, progression-free survival, and overall survival in second-line treatment, whereas regorafenib provides benefits to patients progressing on all standard therapies. Several novel therapeutic options for patients with mCRC are under development, and these are discussed.
authors.affiliation: Medical Oncology Department, Navarra Hospital Complex, Calle Irunlarrea, 3, 31008, Pamplona, Navarra, Spain. ruth.vera.garcia@cfnavarra.es.
authors.forename: Ruth
authors.initials: R
authors.lastname: Vera
authors.affiliation: Medical Oncology Department, Miguel Servet University Hospital, Saragossa, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Alonso
authors.affiliation: Medical Oncology Department, Elche General University Hospital, Elche, Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gállego
authors.affiliation: Medical Oncology Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Encarnación
authors.initials: E
authors.lastname: González
authors.affiliation: Medical Oncology Department, IRYCIS, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Guillén-Ponce
authors.affiliation: Medical Oncology Department, Sabadell University Hospital, Sabadell, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Pericay
authors.affiliation: Medical Oncology Department, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rivera
authors.affiliation: Medical Oncology Department, General University Hospital of Valencia, Valencia, Spain.
authors.forename: M José
authors.initials: MJ
authors.lastname: Safont
authors.affiliation: Medical Oncology Department, Biomedical Research Institute INIBIC, A Coruña University Hospital, A Coruña, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Valladares-Ayerbes
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery; D003131:Combined Modality Therapy / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000556:secondary*; D058990:Molecular Targeted Therapy; D011379:Prognosis
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D015415:Biomarkers
keywords: Aflibercept; Anti-EGFR therapy; Bevacizumab; Liver metastases; Regorafenib