Korean J Gastroenterol.  2009 Dec;54(6):355-363. 10.4166/kjg.2009.54.6.355.

Chemotherapy for Colorectal Cancer

• Hong YS
• Kim TW

• KMID: 1775934
• DOI: http://doi.org/10.4166/kjg.2009.54.6.355

Abstract

Recent advances in chemotherapy lead to improved survival outcomes in patients with colorectal cancer. The 5-fluorouracil (5-FU) is still one of the important chemotherapeutic agents since 1950s, but the introduction of newer cytotoxic agents, irinotecan and oxaliplatin, or targeted agents, bevacizumab and cetuximab, have changed treatment strategies for these patients. A deliberate choice should be made for adjuvant chemotherapy, because it has became complicated more than ever before. Oxaliplatin plus 5-FU seemed to be superior in terms of disease-free and overall survival than 5-FU alone after curative surgery for colon cancers. However not all of these patients seemed to receive benefit from this intensive adjuvant treatment, and some limitations are present according to the postoperative stage, tumor biology and clinical characteristics. For metastatic disease, there is no doubt that more complicated strategies are present because we have more abundant chemotherapeutic agents available for metastatic setting compared to adjuvant setting. Recently, targeted agents, such as bevacizumab or cetuximab, also took an important place in the treatment of metastatic colorectal cancer, and many efforts are also made to find the biomarkers for predicting treatment responses to these targeted agents. In this review, we intended to sort up the standard strategies of chemotherapy for patients with colorectal cancer according to the latest pivotal publications.

Keyword

Colorectal cancer; Chemotherapy; Targeted agents

MeSH Terms

Antibodies, Monoclonal/therapeutic use
Antineoplastic Agents/therapeutic use
Chemotherapy, Adjuvant
Colorectal Neoplasms/*drug therapy/surgery
Drug Therapy, Combination
Fluorouracil/therapeutic use
Humans
Organoplatinum Compounds/therapeutic use
ras Proteins/genetics/metabolism

Figure

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  Fig. 1. Improvement of overall survival in patients with metastatic colorectal cancer according to the recent advances in chemotherapy.

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  Fig. 2. Cetuximab and Kras modulate signaling through the epidermal growth factor receptor (EGFR) pathway. (A) Binding of ligand to EGFR triggers signaling through ras/MAPK pathway to multiple targets that may regulate ligand levels. (B) In the presence of cetuximab, ligand binding is prevented, and there is deactivation of EGFR signaling in cells dependent on this pathway. (C) Kras mutations can lead to dysregulation of MAPK pathway and downstream signaling in the absence of ligand-dependent receptor activation.

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