title: Therapeutic strategy in unresectable metastatic colorectal cancer: an updated review.
abstract: Systemic therapy is the standard care for patients with unresectable advanced colorectal cancer (CRC), but salvage surgery of metastatic disease should be considered in the case of adequate tumor shrinkage. Several drugs and combinations are now available for use in treating patients with advanced CRC, but the optimal sequence of therapy remains unknown. Moreover, the administration of antitumor therapy can be modulated by periods of maintenance or treatment breaks rather than delivered as full therapy until disease progression or unacceptable toxicity, followed by reintroduction of prior full therapy when required, before switching to other drugs. Consequently, randomized strategy trials are needed to define the optimal treatment sequences. Molecular testing for Kirsten rat sarcoma viral oncogene homolog (KRAS) and neuroblastoma RAS viral oncogene homolog (NRAS) is mandatory but not sufficient to select appropriate patients for epidermal growth factor receptor (EGFR) monoclonal antibody (MoAb) therapy.
authors.affiliation: Department of Medical Oncology, Institut Hospitalier Franco-Britannique, 4, rue Kléber, 92300, Levallois-Perret, France.
authors.forename: Benoist
authors.initials: B
authors.lastname: Chibaudel
authors.affiliation: Hôpitaux de Paris, Créteil, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tournigand
authors.affiliation: Methodology and biostatistics Unit, Hôpital Besançon, Besançon, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bonnetain
authors.affiliation: Department of Surgery, Institut Hospitalier Franco-Britannique, Levallois-Perret, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Richa
authors.affiliation: GERCOR, Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France and.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Benetkiewicz
authors.affiliation: Department of Medical Oncology, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: André
authors.affiliation: Department of Medical Oncology, Institut Hospitalier Franco-Britannique, Levallois-Perret, France and GERCOR, Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France.
authors.forename: Aimery
authors.initials: A
authors.lastname: de Gramont
keywords: chemotherapy; colorectal cancer; maintenance; molecular targeted agents; strategy; treatment