Systematic Review
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2014; 6(6): 177-183
Published online Jun 15, 2014. doi: 10.4251/wjgo.v6.i6.177
Current status of pharmacological treatment of colorectal cancer
Reyhan Akhtar, Shammy Chandel, Pooja Sarotra, Bikash Medhi
Reyhan Akhtar, Shammy Chandel, Pooja Sarotra, Bikash Medhi, Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Akhtar R and Medhi B designed the study; Akhtar R and Chandel S performed the study; Akhtar R and Sarotra P analyzed the data; Akhtar R and Chandel S wrote the paper.
Correspondence to: Bikash Medhi, MD, Additional Professor, Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. drbikashus@yahoo.com
Telephone: +91-172- 2755250 Fax: +91-172-2744401
Received: December 11, 2013
Revised: February 18, 2014
Accepted: March 8, 2014
Published online: June 15, 2014
Abstract

AIM: To review the clinical trials for the development in drugs for chemotherapeutic treatment of colorectal cancer (CRC).

METHODS: A systematic review identified randomized controlled trials (RCTs) assessing drugs for the treatment of CRC or adenomatous polyps from www.clinicaltrials.gov. Various online medical databases were searched for relevant publications.

RESULTS: Combination treatment regimens of standard drugs with newer agents have been shown to improve overall survival, disease-free survival, time to progression and quality of life compared to that with standard drugs alone in patients with advanced colorectal cancer. The FOLFOXIRI regimen has been associated with a significantly higher response rate, progression-free survival and overall survival compared to the FOLFIRI regimen.

CONCLUSION: Oxaliplatin plus intravenous bolus fluorouracil and leucovorin has been shown to be superior for disease-free survival when compared to intravenous bolus fluorouracil and leucovorin. In addition, oxaliplatin regimens were more likely to result in successful surgical resections. First line treatment with cetuximab plus fluorouracil, leucovorin and irinotecan has been found to reduce the risk of metastatic progression in patients with epidermal growth factor receptor-positive colorectal cancer with unresectable metastases. The addition of bevacizumab has been shown to significantly increase overall and progression-free survival when given in combination with standard therapy.

Keywords: Colorectal cancer, Metastasis, Chemotherapy, 5-fluorouracil, Leucovorin, Epidermal growth factor receptor inhibitor

Core tip: A systematic review was undertaken to identify randomized controlled trials (RCTs) assessing synthetic drugs for the treatment of colorectal cancer and/or adenomatous polyps from various medical databases, including clinicaltrials.gov, and a total of around 2300 RCTs were screened. After reviewing data from RCTs of synthetic drugs, alone or in combination with biological agents, for the treatment of colorectal cancer, it was concluded that combination regimens of standard chemotherapeutic drugs with new cytotoxic and targeted agents have led to an increase in overall and progression-free survival and have also contributed to increased rates of resectability and improved health-related quality of life in patients.