Metastatic colorectal cancer

Hepatic arterial chemotherapy for colorectal cancer metastatic to the liver. Oncology 2000 59 89-97... 

Jakobs et al. [35] reported results on 39 treated patients (17 women, 22 men) that included colorectal cancer, metastatic breast cancer, hepatocellular carcinoma, neuroendocrine tumors, and a mixed group composed of metastatic pancreatic cancer, carcinoma of unknown primary, cholangiocellular carcinoma, thymus carcinoma, malignant melanoma, and choroid melanoma. In this mixed tumor group, two patients were lost for follow-up immediately after treatment. Two patients died before first follow-up 3 months after SIRT (one patient with choroid melanoma and one with carcinoma of unknown primary). However, at the first followup 3-4 months after SIRT, five of six patients presented with stable disease or partial response. The same applied for two of three patients at the followup at 5-6 months. Stable disease was noted in two of three patients at 10-11 months after SIRT. The median time to progression was 8 months (range 3-11 months), although two patients were lost and two died before first follow-up and were therefore not included in this analysis. The median survival was 2.2 months. 

Hemingway A, Allison DJ (1988) Complications of embolization analysis of 410 procedures. Radiology 166 669-672 Hu G et al. (2001) 40% response rate after hepatic arterial infusion of CPT-11 in patients with colorectal cancer metastatic to the liver. ASCO 37th Annual Meeting, San Francisco California... 

Bevacizumab (Avastin ) Roche mAb VEGFR Metastatic colorectal cancer... 

ADCC. Cetuximab is approved for treatment of metastatic colorectal cancer (CRC) and squamous cell carcinoma of the head and neck (SCCHN). Interestingly, an adverse event, acneiform rash seems to correlate with a better response to cetuximab, while there is no such correlation with expression levels of EGFR assessed by immunohistochemistry. Further side effects are rare infusion reactions and hypomagnesia. Two other anti-EGFR antibodies approved for clinical use are the fully human antibody panitumumab (Vectibix)... 

The clinical trial that resulted in FDA approval of bevacizumab (February 2004) was a randomized, double-blind, phase III study in which bevacizumab was administered in combination with bolus-IFL (irinotecan, 5FU, leucovorin) chemotherapy as first-line therapy for previously untreated metastatic colorectal cancer [3]. Median survival was increased from 15.6 months in the bolus-IFL + placebo arm to 20.3 months in the bolus-IFL + bevacizumab arm. 

Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovor-in for metastatic colorectal cancer. N Engl J Med 350 2335-2342... 

Symptom reduction is the primary goal of radiation for patients with advanced or metastatic disease colorectal cancer. 

Finally patients who fail standard treatment for metastatic colorectal cancer should be encouraged to participate in a clinical trial evaluating new treatment approaches for this incurable disease. Table 88-5 lists options for first- and second-line... 

Oxaliplatin (Eloxatin ) is similar to other platinum analogs (e.g., cisplatin) in that it binds to the N-7 position of guanine, which results in cross-linking of DNA and double-stranded DNA breaks.26,40 Oxaliplatin differs from cisplatin in that the DNA damage induced by oxaliplatin may not be as easily recognized by DNA repair genes often seen in colorectal cancer. Oxaliplatin, in combination with 5-FU-based regimens, is indicated for the first- and second-line treatment of metastatic colon cancer, as well as the adjuvant treatment of colon cancer. 

Goldberg RM, Sargent DJ, Morton RF, et al. A randomized, controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 2004 22 23-30. 

Kelly H, Goldberg RM. Systemic therapy for metastatic colorectal cancer Current options, current evidence. J Clin Oncol 2005 10 4553-4560. 

Saltz LB, Cox JV, Blanke C et al. Irino-tecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 2000 343 905-914. 

Avastin (tradename, also known as bevacizumab) is a 149 kDa recombinant humanized monoclonal IgGl antibody first approved for medical use in the USA in 2004, and subsequently in the EU in 2005. It is indicated for first-line treatment of patients with metastatic colorectal cancer, in combination with specified (5-fluorouricil-based) small molecule chemotherapeutic drugs. 

Approximately 20% of patients with colorectal cancer present with metastatic disease. The most common site of metastasis is the liver, followed by the lungs, and then bones. 

Chemotherapy is the primary treatment modality for metastatic colorectal cancer (MCRC). Treatment options are generally similar for metastatic cancer of the colon and rectum. 

Chemotherapeutic Regimens for Metastatic Colorectal Cancer (Continued)... 

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