ABSTRACT
Important developments in chemotherapy for metastatic colorectal cancer over the last years are reviewed, with an emphasis on the most recently published data from clinical trials. The systematic review of current literature was conducted involving Pubmed Central® research and full articles were obtained and analyzed when appropriate. Fluorouracil still constitutes the backbone of metastatic colorectal cancer treatment; fluorouracil combination plus either irinotecan (FOLFIRI), oxaliplatin (FOLFOX) or capecitabine (CAPOX or XELOX) are chemotherapy protocols established as treatments producing similar outcomes. Actual treatment involves these chemotherapy protocols in combination with new molecular targeted drugs: bevacizumab and aflibercept (anti-vascular endothelial growth factor monoclonal antibody) and cetuximab and panitumumab (anti-epidermal growth factor receptor monoclonal antibody for patients with wild type KRAS) which confer significant survival benefits in select patients as first- or second-line therapies. The factors affecting the decisions for one treatment over other are related to the patient and toxicity drug. Finally, metastatic colorectal cancer patients progressing after all standard therapies (maintaining a good ECOG performance status) could be candidates for further therapies such as regorafenib and TAS-102. Regarding the future, promising therapies are under development for the metastatic colorectal cancer treatment and several agents are currently being evaluated in different clinical trials.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colorectal Neoplasms/drug therapy , Bevacizumab , Fluorouracil , Humans , Leucovorin , Neoplasm Metastasis , Organoplatinum Compounds , Vascular Endothelial Growth Factor AABSTRACT
El cáncer colorrectal (CCR) es uno de los cánceres más comúnmente diagnosticados a nivel mundial, constituyendo el tercer tumor de mayor incidencia y la cuarta mayor causa de muerte. El CCR puede clasificarse como esporádico (90-95%) o hereditario y presenta una tasa de mortalidad de 19,6 por cada 100.000 habitantes y una tasa de incidencia de 46,4 por cada 100.000 habitantes. Son varios los factores de riesgo y protectores del CCR que se han descrito, algunos independientes del tipo de vida de los pacientes, sobre todo factores genéticos, y otros dependientes del mismo, como son la dieta, la obesidad, la actividad física, el consumo de tabaco y de alcohol. Las pruebas de cribado del CCR son una de las causas implicadas en la reducción de la mortalidad y de la incidencia del CCR, pues suponen una detección de CCR en estadios no avanzados que permiten afrontar la enfermedad en etapas tempranas proporcionando así mejores pronósticos. Tras el diagnóstico de CCR hay que conocer la estadificación del mismo para poder emplear el mejor esquema de quimioterapia posible. La quimioterapia adyuvante se emplea tras la intervención quirúrgica con carácter curativo, principalmente en pacientes con CCR en estadios II de alto riesgo y estadio III (tumores localmente avanzados). Los pacientes con tumores en estadio IV (tumor extendido a otros órganos) se benefician de la quimioterapia neoadyuvante, administrada previamente a la intervención quirúrgica con el fin de reducir el tumor. Estos esquemas de tratamiento se basan en combinaciones de quimioterapia y terapias dirigidas (AU)
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the world, it is the third most prevalent tumor and the fourth cause of death. CRC can be classified as sporadic (90-95 %) or hereditary and it has a mortality rate of 19.6 per 100,000 inhabitants and an incidence rate of 46.4 per 100,000 inhabitants. Several risk and protective factors have been described according CRC, some independent of the patients' life-style, especially genetic factors, and others dependent on it, such as diet, obesity, physical activity, tobacco and alcohol. CRC screening tests are one of the causes involved in the reduction of mortality and the incidence of CRC, because they involve CRC detection in non-advanced stages that allow the disease to be treated in the early stages, providing better predictions. After the diagnosis of CRC, it is necessary to know the staging of the tumor in order to be able to use the best possible chemotherapy regimen. Adjuvant chemotherapy is used after curative surgery, mainly in patients with CRC in stage II with high risk and stage III (locally advanced tumors). Patients with stage IV tumors (metastasic tumor) benefit from neoadjuvant chemotherapy, which is previously administered to the surgical intervention in order to reduce the tumor. These treatment regimens are based on combinations of chemotherapy and molecular targeted therapies (AU)
