Treatment decisions after diagnosis of metastatic colorectal cancer.

摘要: Treatment of metastatic colorectal cancer (mCRC) involves the use active cytotoxic drugs (irinotecan, oxaliplatin, 5-fluorouracil [5-FU], and capecitabine) biological agents (bevacizumab, cetuximab, panitumumab) either in combination or as single agents. Until recently, only agent with proven first-line efficacy was bevacizumab, but options have expanded from data generated anti-endothelial growth factor (EGFR) monoclonal antibodies. Anti-EGFR can be added to FOLFIRI (5-fluorouracil, leucovorin [folinic acid], irinotecan) FOLFOX oxaliplatin) patients whose tumors express wild-type KRAS. These may improve outcomes when chemotherapy, particularly progression-free survival (PFS), case overall (OS) response rates. The selection therapy should based on individual treatment goals after considering tolerability each regimen. For metastases confined liver, surgical resection offers a potentially curative approach. initially unresectable lesions, regimens offering high rates produce sufficient tumor shrinkage permit complete resection. Regimens are also preferable for requiring symptom relief those large burdens. choice between intensive vs. nonintensive management depends other factors, including patient's functional status, comorbidities, desires. A sequential single-agent strategy an intermittent approach (combination followed by maintenance) minimize toxicity appropriate who not candidates, irrespective response. Guidelines, such National Comprehensive Cancer Network (NCCN), recommend that KRAS mutational status determined at mCRC diagnosis identify candidates anti-EGFR whether they used first subsequent lines treatment.