Contemporary Evidence-Based Management of Newly Diagnosed Metastatic Colorectal Cancer

摘要: With an estimated 1.3 million new cancer cases and 700,000 deaths worldwide, colorectal (CRC) is a major cause of cancer-related morbidity mortality globally. The incidence CRC higher in developed countries compared with developing countries, the overall age-adjusted rate 36.3 per 100,000 population. Despite decreasing CRC, total 132,700 49,700 are to occur United States 2015, making it second most common mortality. About 20% all metastatic at diagnosis, approximately 30% stage II III will develop recurrent disease after initial treatment. Medical oncologists frequently encounter patients understanding nuances treating this vital for improved outcomes these patients. This review summarizes existing evidence underlying paradigm treatment first-line setting. An armamentarium therapies has accumulated over past few decades leading incremental increase survival disease. However, composite array cytotoxic targeted made relatively complicated. Currently approved agents include cytotoxics: 5-fluorouracil (5-FU), capecitabine, oxaliplatin, irinotecan; therapies: bevacizumab, cetuximab, panitumumab, regorafenib, ziv-aflibercept, ramucirumab (Figure Table).5-15 Apart from which refractory setting, aflibercept ramucirumab, oxaliplatin-resistant patients, other drugs can be used Consequently, selecting appropriate therapy complex critical decision that medical need make on routine basis. For purpose we have divided into 2 main modules: choice chemotherapy backbone biologic agent. last section deals management elderly due singular issues scope restricted systemic does not surgical or locoregional strategies. patient selection multidisciplinary care involving liver resection perioperative chemotherapy, small subset limited achieve long-term control even cure.16 5-year select approaches 50%. Abstract