Current Standard Of Care For Metastatic Colorectal Cancer

Until the year 2000, the only systemic therapy for metastatic CRC was a bolus or infusional 5-FU regimen, mostly in combination with leucovorin (5-FU/LV), achieving a median survival of 12 month (20). However, over the last 6 years many new agents have been developed and approved by the Federal Drug and Food Administration (FDA) for the treatment of mCRC (7). A summary of the current guidelines for treating colorectal cancer is shown in Table 1.

Irinotecan (CPT-11), a prodrug of SN 38, achieves its anti-carcinogenic effect through inhibiting topoisomerase I, an enzyme involved in the relaxation of supercoiled DNA (21). Oxaliplatin is a platinum analog that inhibits DNA synthesis through the formation of intra-strand DNA adducts and is currently approved by the FDA for use both in adjuvant and metastatic settings (22). CPT-11 and oxaliplatin, when combined with 5-FU/LV based chemotherapy regimens, have boosted response rates (RR) and overall-survival (OS) to 50% and at least 16 months, respectively, compared to 20% and 10-12 month with 5-FU/LV mono-chemotherapy (23).

Table 1

Current Standard of Care for Colorectal Cancer (CRC)

Table 1

Current Standard of Care for Colorectal Cancer (CRC)

Early Stage

Adjuvant

Neoadjuvant

Metastatic

Second Line

Resectable:

Capecitabine or

FOLFOX or

Bevacizumab

Irinotecan or

Surgery and

FOLFOX

FOLFIRI

plus: FOLFOX

irinotecan

surveillance

with or

or FOLFIRI or

plus

Adjuvant therapy

without

CapeOx

cetuximab,

Unresectable:

Rectal:

bevacizumab

FOLFOX, or

Neoadjuvant

Radiation with

FOLFIRI

therapy plus

5-FU or

surgery

capecitabine

From Ref. (85). Abbreviations: 5-FU/LV (5-fluorouracil plus leucovorin); CapeOx (capecitabine plus oxaliplatin); FOLFIRI (infusional 5-FU/LV plus irinotecan); FOLFOX (infusional 5-FU/LV plus oxaliplatin).

From Ref. (85). Abbreviations: 5-FU/LV (5-fluorouracil plus leucovorin); CapeOx (capecitabine plus oxaliplatin); FOLFIRI (infusional 5-FU/LV plus irinotecan); FOLFOX (infusional 5-FU/LV plus oxaliplatin).

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment