Palliative Treatment of Metastatic Colorectal Cancer: What is the Optimal Approach?
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Worldwide, colorectal cancer (CRC) is responsible for over 600,000 deaths annually and remains a significant public health concern. Because of therapeutic advancements over the past two decades, patients with metastatic CRC are living longer with an improved quality of life. This review will highlight recent trial evidence that improves outcomes for patients with metastatic disease. Topics will include the optimal use of first-line combination chemotherapy, bevacizumab in patients with advanced age or comorbidities, maintenance chemotherapy, first-line use of anti-EGFR therapies, first-line cetuximab versus bevacizumab, anti-angiogenic therapies past progression, and management of treatment-refractory disease. Clinical trial evidence will be presented, along with guidance on how to integrate recent evidence into clinical practice. Finally, this review will examine innovative drug development strategies, and will discuss potentially actionable targets identified by molecular testing.
KeywordsMetastatic colorectal cancer Bevacizumab Cetuximab Panitumumab Maintenance chemotherapy Palliative chemotherapy FOLFOX FOLFIRI FOLFOXIRI Bevacizumab in the elderly Ziv-aflibercept Regorafenib HER2 c-MET
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Conflict of Interest
John H. Strickler is on an advisory board for Amgen and has received payment for CME lectures supported by Lily USA, LLC for The Academy for Healthcare Learning.
Herbert I. Hurwitz is a consultant for from Genetech, Roche, Pfizer, Sanofi, Regeneron, BMS, Lilly, GSK, Threshold, Tracon, and Amgen; has grants pending from Genetech, Roche, Pfizer, Sanofi, Regeneron, BMS, Lilly, GSK, Threshold, Tracon, and Amgen; and has received honoraria from Roche.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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