TY - JOUR
T1 - A systematic review of salvage therapy to patients with metastatic colorectal cancer previously treated with fluorouracil, oxaliplatin and irinotecan +/- targeted therapy
AU - Nielsen, Dorte Lisbet
AU - Palshof, Jesper Andreas
AU - Larsen, Finn Ole
AU - Jensen, Benny Vittrup
AU - Pfeiffer, Per
N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.
PY - 2014/7
Y1 - 2014/7
N2 - Oxaliplatin, irinotecan and 5-fluorouracil in combination with or without targeted therapies are well-documented treatment options for first- and second-line treatments of metastatic colorectal cancer. However, there are much less data on the beneficial effect on systemic therapy in the third-line setting. We therefore performed a systematic review of the current literature on third or later lines of treatment to patients with metastatic colorectal cancer after the use of approved drugs or combinations. Methods: A computer-based literature search was carried out using Pubmed and data reported at international meetings. Original studies reporting ≥15 patients who had previously received 5-fluorouracil, oxaliplatin and irinotecan were included. Furthermore, patients with KRAS wild type tumours should had received EGFR-directed therapy. Results: Conventional chemotherapeutic agents as capecitabine, mitomycin C, and gemcitabine have limited or no activity. Retreatment with oxaliplatin might be an option in selected patients. In addition, rechallenge with EGFR-directed therapy might be a valuable strategy. Data also suggest that angiogenetic drugs may postpone further progression and prolong survival. Lately, regorafinib has been approved. In conclusion, our current knowledge is based on many retrospective studies, some phase II studies and very few randomized clinical trials. Further prospective phase III trials comparing an investigational drug or combination with best supportive care in third- or later lines of treatment in metastatic colorectal cancer are highly warranted. Identification of predictive biomarkers and improvement of our understanding of molecular mechanisms is crucial.
AB - Oxaliplatin, irinotecan and 5-fluorouracil in combination with or without targeted therapies are well-documented treatment options for first- and second-line treatments of metastatic colorectal cancer. However, there are much less data on the beneficial effect on systemic therapy in the third-line setting. We therefore performed a systematic review of the current literature on third or later lines of treatment to patients with metastatic colorectal cancer after the use of approved drugs or combinations. Methods: A computer-based literature search was carried out using Pubmed and data reported at international meetings. Original studies reporting ≥15 patients who had previously received 5-fluorouracil, oxaliplatin and irinotecan were included. Furthermore, patients with KRAS wild type tumours should had received EGFR-directed therapy. Results: Conventional chemotherapeutic agents as capecitabine, mitomycin C, and gemcitabine have limited or no activity. Retreatment with oxaliplatin might be an option in selected patients. In addition, rechallenge with EGFR-directed therapy might be a valuable strategy. Data also suggest that angiogenetic drugs may postpone further progression and prolong survival. Lately, regorafinib has been approved. In conclusion, our current knowledge is based on many retrospective studies, some phase II studies and very few randomized clinical trials. Further prospective phase III trials comparing an investigational drug or combination with best supportive care in third- or later lines of treatment in metastatic colorectal cancer are highly warranted. Identification of predictive biomarkers and improvement of our understanding of molecular mechanisms is crucial.
KW - Alanine
KW - Angiogenesis Inhibitors
KW - Antibodies, Monoclonal, Humanized
KW - Antineoplastic Combined Chemotherapy Protocols
KW - Camptothecin
KW - Colorectal Neoplasms
KW - Databases, Factual
KW - Fluorouracil
KW - Hepatic Artery
KW - Humans
KW - Infusions, Intra-Arterial
KW - Liver Neoplasms
KW - Molecular Targeted Therapy
KW - Organoplatinum Compounds
KW - Phenylurea Compounds
KW - PubMed
KW - Pyridines
KW - Receptor, Epidermal Growth Factor
KW - Retreatment
KW - Salvage Therapy
KW - Treatment Failure
KW - Triazines
U2 - 10.1016/j.ctrv.2014.02.006
DO - 10.1016/j.ctrv.2014.02.006
M3 - Review
C2 - 24731471
SN - 0305-7372
VL - 40
SP - 701
EP - 715
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
IS - 6
ER -
