Published online Jan 28, 2014. doi: 10.3748/wjg.v20.i4.899
Revised: October 27, 2013
Accepted: December 12, 2013
Published online: January 28, 2014
Choice of first line treatment for patients with metastatic colorectal cancer (mCRC) is based on tumour and patient related factors and molecular information for determination of individual treatment aim and thus treatment intensity. Recent advances (e.g., extended RAS testing) enable tailored patient assignment to the most beneficial treatment approach. Besides fluoropyrimidines, irinotecan and oxaliplatin, a broad variety of molecular targeting agents are currently available, e.g., anti-angiogenic agents (bevacizumab) and epidermal growth factor receptor (EGFR) antibodies (cetuximab, panitumumab) for first line treatment of mCRC. Although some combinations should be avoided (e.g., oral or bolus fluoropyrimidines, oxaliplatin and EGFR antibodies), treatment options range from single agent to highly effective four-drug regimen. Preliminary data comparing EGFR antibodies and bevacizumab, both with chemotherapy, seem to favour EGFR antibodies in RAS wildtype disease. However, choosing the most appropriate treatment approach for mCRC patients remains a complex issue, with numerous open questions.
Core tip: Selection of the optimal first line treatment for metastatic colorectal cancer is a complex issue influencing course of disease and most likely survival of the individual patient. Available data will be analyzed to allow for a patient and disease specific, molecularly stratified treatment approach, applying systemic treatment (chemotherapy and antibodies) and locally ablative measures (surgery and radiofrequency ablation).