Раковая наука и терапия

What is the Optimal Treatment for Metastatic Colorectal Cancer? Controversial Points

Abstract

Esther Uña Cidón

Colorectal cancer (CRC) is the second leading cause of death from cancer in the developed countries. Although great efforts have been made to achieve an early diagnosis, a large number of cases will present metastases. The natural history of metastatic (m) CRC has dramatically evolved in the recent years thanks to the introduction of modern chemotherapy and molecular therapies. With these agents the response rate has increased to 50% and survival has been improved not only progression free survival (PFS), which has reached 12 months, but also overall survival (OS) which is longer than 2 years.   Despite this progress many questions remain to be answered, mainly those related to the sequential regimens, drug rotation, alternant or intermitent schedules, optimal duration of chemotherapy, the role of maintenance chemotherapy and the role of doublets or triplets.   The optimal duration of chemotherapy is very important because it has a direct influence on the patient quality of life, survival and costs. There are several studies addressing this topic and the alternatives we have, such as “stop and go”, intermittent strategies or maintenance of only several agents and these studies reinforce the frequent behaviour of the oncologists to stop the treatment when the patient has obtained the maximum response. But there are some methodological problems in the analyzed trials which have determined that not all the professionals agree with this proposal.   With this context it is essential to perform well designed clinical trials incorporating new drugs and addressing these questions. This article tries to review briefly all these controversial points.