Topic Highlight
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 14, 2013; 19(46): 8474-8488
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8474
Evidence-based appraisal of the upfront treatment for unresectable metastatic colorectal cancer patients
Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi
Giuseppe Aprile, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Marta Bonotto, Elena Ongaro, Fabio Puglisi, Department of Oncology, University and General Hospital, 33100 Udine, Italy
Fabio Puglisi, Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
Author contributions: All authors contributed equally to the intellectual conception of the manuscript and approved the final version; Aprile G, Lutrino ES, Ferrari L, Casagrande M, Bonotto M and Ongaro E performed extensive literature research and drafted the article; Aprile G and Puglisi F revised the manuscript critically.
Correspondence to: Giuseppe Aprile, MD, Department of Oncology, University and General Hospital, Piazzale S Maria della Misericordia 1, 33100 Udine, Italy. aprile.giuseppe@aoud.sanita.fvg.it
Telephone: +39-432-559308   Fax: +39-432-559305
Received: September 18, 2013
Revised: November 13, 2013
Accepted: December 3, 2013
Published online: December 14, 2013
Processing time: 91 Days and 12.4 Hours
Abstract

Colorectal cancer (CRC) is a significant health problem, with around 1 million new cases and 500000 deaths every year worldwide. Over the last two decades, the use of novel therapies and more complex treatment strategies have contributed to progressively increase the median survival of patients with unresectable advanced CRC up to approximately 30 mo. The availability of additional therapeutic options, however, has created new challenges and generated more complicated treatment algorithms. Moreover, several clinically important points are still in debate in first-line, such as the optimal treatment intensity, the most appropriate maintenance strategy, the preferred biologic to be used upfront in patients with KRAS wild-type CRC, and the need for more detailed information on tumor biology. In this moving landscape, this review analyses why the first-line treatment decision is crucial and how the choice may impact on further treatment lines. In addition, it focuses on results of major phase III randomized trials.

Keywords: Colorectal cancer; Chemotherapy; Angiogenic inhibitors; Epidermal growth factor receptor inhibitors; Maintenance; First-line

Core tip: The choice of the first-line therapy is crucial for patients with advanced, unresectable colorectal cancer. The aim of this review is to critically focus on updated scientific data that medical oncologists need to interpret to make the most appropriate evidence-based choice among many possible treatment options.