Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease

doi:10.3390/jcm9123889

Review

. 2020 Nov 30;9(12):3889.

doi: 10.3390/jcm9123889.

Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease

Jorge Aparicio¹, Francis Esposito², Sara Serrano³, Esther Falco⁴, Pilar Escudero⁵, Ana Ruiz-Casado⁶, Hermini Manzano⁷, Ana Fernandez-Montes⁸

Affiliations

¹ Department of Medical Oncology, Hospital Universitario y Politecnico La Fe, E-46007 Valencia, Spain.
² Department of Medical Oncology, Hospital Clinic, E-08041 Barcelona, Spain.
³ Department of Medical Oncology, Hospital Universitario Sant Joan de Reus, E-43204 Reus, Spain.
⁴ Department of Medical Oncology, Hospital Son Llatzer, E-07004 Palma de Mallorca, Spain.
⁵ Department of Medical Oncology, Hospital Clínico Universitario Lozano Blesa, E-50002 Zaragoza, Spain.
⁶ Department of Medical Oncology, Hospital Universitario Puerta de Hierro, E-28220 Madrid, Spain.
⁷ Department of Medical Oncology, Hospital Quirón Salud Palmaplanas, E-07004 Palma de Mallorca, Spain.
⁸ Department of Medical Oncology, Complejo Hospitalario de Orense, E-32001 Orense, Spain.

PMID: 33265959
PMCID: PMC7761096
DOI: 10.3390/jcm9123889

Review

Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease

Jorge Aparicio et al. J Clin Med. 2020.

. 2020 Nov 30;9(12):3889.

doi: 10.3390/jcm9123889.

Authors

Jorge Aparicio¹, Francis Esposito², Sara Serrano³, Esther Falco⁴, Pilar Escudero⁵, Ana Ruiz-Casado⁶, Hermini Manzano⁷, Ana Fernandez-Montes⁸

Affiliations

¹ Department of Medical Oncology, Hospital Universitario y Politecnico La Fe, E-46007 Valencia, Spain.
² Department of Medical Oncology, Hospital Clinic, E-08041 Barcelona, Spain.
³ Department of Medical Oncology, Hospital Universitario Sant Joan de Reus, E-43204 Reus, Spain.
⁴ Department of Medical Oncology, Hospital Son Llatzer, E-07004 Palma de Mallorca, Spain.
⁵ Department of Medical Oncology, Hospital Clínico Universitario Lozano Blesa, E-50002 Zaragoza, Spain.
⁶ Department of Medical Oncology, Hospital Universitario Puerta de Hierro, E-28220 Madrid, Spain.
⁷ Department of Medical Oncology, Hospital Quirón Salud Palmaplanas, E-07004 Palma de Mallorca, Spain.
⁸ Department of Medical Oncology, Complejo Hospitalario de Orense, E-32001 Orense, Spain.

PMID: 33265959
PMCID: PMC7761096
DOI: 10.3390/jcm9123889

Abstract

Colorectal cancer (CRC) is a commonly diagnosed malignancy. The prognosis of patients with unresectable, metastatic colorectal cancer (mCRC) is dismal and medical treatment is mainly palliative in nature. Although chemotherapy remains the backbone of treatment, the landscape is changing with the understanding of its heterogeneity and molecular biology. First-line therapy relies on a combination of chemotherapy and targeted therapies, according to clinical patient characteristics and tumor molecular profile. Here we review current evidence from randomized clinical trials for using chemotherapy doublets or triplets, and for the addition of bevacizumab or anti-epidermal growth factor receptor (EGFR) agents. Novel therapies developed for small, selected populations are also discussed.

Keywords: chemotherapy; colorectal cancer; metastatic disease; targeted agents.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

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1. Tournigand C., André T., Achille E., Lledo G., Flesh M., Mery-Mignard D., Quinaux E., Couteau C., Buyse M., Ganem G., et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. J. Clin. Oncol. 2004;22:229. doi: 10.1200/JCO.2004.05.113. - DOI - PubMed
1. Koopman M., Antonini N.F., Douma J., Wals J., Honkoop A.H., Erdkamp F.L., de Jong R.S., Rodenburg C.J., Vreugdenhil G., Loosveld O.J., et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): A phase III randomised controlled trial. Lancet. 2007;370:135. doi: 10.1016/S0140-6736(07)61086-1. - DOI - PubMed
1. Marques R.P., Duarte G.S., Sterrantino C., Pais H.L., Quintela A., Martins A.P., Costa J. Triplet (FOLFOXIRI) versus doublet (FOLFOX or FOLFIRI) backbone chemotherapy as first-line treatment of metastatic colorectal cancer: A systematic review and meta-analysis. Crit. Rev. Oncol. Hematol. 2017;118:54–62. doi: 10.1016/j.critrevonc.2017.08.006. - DOI - PubMed

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[1] Gómez-España M.A., Gallego J., González-Flores E., Maurel J., Páez D., Sastre J., Aparicio J., Benavides M., Feliu J., Vera R. SEOM clinical guidelines for diagnosis and treatment of metastatic colorectal cancer (2018) Clin. Transl. Oncol. 2019;21:46–54. doi: 10.1007/s12094-018-02002-w. - DOI - PMC - PubMed

[2] Gómez-España M.A., Gallego J., González-Flores E., Maurel J., Páez D., Sastre J., Aparicio J., Benavides M., Feliu J., Vera R. SEOM clinical guidelines for diagnosis and treatment of metastatic colorectal cancer (2018) Clin. Transl. Oncol. 2019;21:46–54. doi: 10.1007/s12094-018-02002-w. - DOI - PMC - PubMed

[3] Van Cutsem E., Cervantes A., Adam R., Sobrero A., Van Krieken J.H., Aderka D., Aranda Aguilar E., Bardelli A., Benson A., Bodoky G., et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann. Oncol. 2016;27:1386–1422. doi: 10.1093/annonc/mdw235. - DOI - PubMed

[4] Van Cutsem E., Cervantes A., Adam R., Sobrero A., Van Krieken J.H., Aderka D., Aranda Aguilar E., Bardelli A., Benson A., Bodoky G., et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann. Oncol. 2016;27:1386–1422. doi: 10.1093/annonc/mdw235. - DOI - PubMed

[5] Tournigand C., André T., Achille E., Lledo G., Flesh M., Mery-Mignard D., Quinaux E., Couteau C., Buyse M., Ganem G., et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. J. Clin. Oncol. 2004;22:229. doi: 10.1200/JCO.2004.05.113. - DOI - PubMed

[6] Tournigand C., André T., Achille E., Lledo G., Flesh M., Mery-Mignard D., Quinaux E., Couteau C., Buyse M., Ganem G., et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: A randomized GERCOR study. J. Clin. Oncol. 2004;22:229. doi: 10.1200/JCO.2004.05.113. - DOI - PubMed

[7] Koopman M., Antonini N.F., Douma J., Wals J., Honkoop A.H., Erdkamp F.L., de Jong R.S., Rodenburg C.J., Vreugdenhil G., Loosveld O.J., et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): A phase III randomised controlled trial. Lancet. 2007;370:135. doi: 10.1016/S0140-6736(07)61086-1. - DOI - PubMed

[8] Koopman M., Antonini N.F., Douma J., Wals J., Honkoop A.H., Erdkamp F.L., de Jong R.S., Rodenburg C.J., Vreugdenhil G., Loosveld O.J., et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): A phase III randomised controlled trial. Lancet. 2007;370:135. doi: 10.1016/S0140-6736(07)61086-1. - DOI - PubMed

[9] Marques R.P., Duarte G.S., Sterrantino C., Pais H.L., Quintela A., Martins A.P., Costa J. Triplet (FOLFOXIRI) versus doublet (FOLFOX or FOLFIRI) backbone chemotherapy as first-line treatment of metastatic colorectal cancer: A systematic review and meta-analysis. Crit. Rev. Oncol. Hematol. 2017;118:54–62. doi: 10.1016/j.critrevonc.2017.08.006. - DOI - PubMed

[10] Marques R.P., Duarte G.S., Sterrantino C., Pais H.L., Quintela A., Martins A.P., Costa J. Triplet (FOLFOXIRI) versus doublet (FOLFOX or FOLFIRI) backbone chemotherapy as first-line treatment of metastatic colorectal cancer: A systematic review and meta-analysis. Crit. Rev. Oncol. Hematol. 2017;118:54–62. doi: 10.1016/j.critrevonc.2017.08.006. - DOI - PubMed

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Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease

Affiliations

Metastatic Colorectal Cancer. First Line Therapy for Unresectable Disease

Authors

Affiliations

Abstract

Conflict of interest statement

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