A systematic review of salvage therapy to patients with metastatic colorectal cancer previously treated with fluorouracil, oxaliplatin and irinotecan +/- targeted therapy

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 -