Review

International Journal of Colorectal Disease

, Volume 24, Issue 6, pp 605-612

First online:

Irinotecan as palliative chemotherapy for metastatic colorectal cancer: evolving tactics following initial treatment

  • Emmanuel MitryAffiliated withHépatogastroentérologie et oncologie digestive, Hôpital Ambroise Paré Email author 
  • , Astrid LièvreAffiliated withInserm UMR-S775, Bases moléculaires de la réponse aux xénobiotiques, Université Paris-Descartes
  • , Jean-Baptiste BachetAffiliated withHépatogastroentérologie et oncologie digestive, Hôpital Ambroise Paré
  • , Philippe RougierAffiliated withHépatogastroentérologie et oncologie digestive, Hôpital Ambroise Paré

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Abstract

Background

Patients with metastatic colorectal cancer (mCRC) who progress despite treatment with fluoropyrimidine and irinotecan or oxaliplatin have diminished survival, but they may derive clinically meaningful benefit from second-line or later chemotherapy.

Materials and methods

Literature from 2000 through mid-2008 on the treatment of patients with unresectable mCRC was reviewed to identify options for chemotherapy-resistant patients with mCRC.

Results and conclusions

A recurring finding is that overall survival increases when patients are exposed to all available active agents throughout their course of care, independent of the line of treatment in which medication is delivered. Sequential administration of agents, including irinotecan, oxaliplatin, bevacizumab, and cetuximab, or, alternatively, deferred administration of various medications in combination, have shown promising efficacy that is at least equivalent to established combination regimens with the same agents. Palliative chemotherapy clearly improves survival in patients with unresectable mCRC, with overall survival recently reaching 28 months.

Keywords

Bevacizumab Capecitabine Combination treatment FOLFIRI FOLFOX Targeted agents