J Korean Med Assoc.  2010 Jul;53(7):582-591. 10.5124/jkma.2010.53.7.582.

Chemotherapy for Colorectal Cancer

• Hong YS
• Kim TW

• KMID: 2188334
• DOI: http://doi.org/10.5124/jkma.2010.53.7.582

Abstract

Survival outcomes have been steadily improving for last 50 years in patients with colorectal cancer. The 5-fluorouracil (5-FU) is still one of the major chemotherapeutic agents. New cytotoxic agents, irinotecan and oxaliplatin, or targeted agents, bevacizumab and cetuximab, have been studied in the treatment of colon cancer. Adjuvant chemotherapy is indicated in patients with colon cancer at high-risk stage II and III, and after complete resection. Oxaliplatin-based regimens, FOLFOX, are considered as the standard adjuvant chemotherapy. If there are contraindications for oxaliplatin, the best alternatives are capecitabine or 5FU/LV. In rectal cancer, adjuvant chemotheradiotherapy is indicated in patients who had curative resection with stage II and III cancer. Adjuvant chemotherapy is necessary after neoadjuvant chemoradiotherapy in rectal cancer. The introduction of novel agents targeted to specific molecular features of cancer cells promises more options and marked improvements in efficacy for treatment of metastatic colon cancer. Bevacizumab has been shown to extend survival in colorectal cancer when used in combination with irinotecan and 5-fluorouracil-based chemotherapy, and the addition of cetuximab to irinotecan and 5-fluorouracil-based chemotherapy eliminates irinotecan resistance. Interestingly, there has been no clear association between the expression of epidermal growth factor receptor (EGFR) and response to the EGFR inhibitors. Instead, KRAS mutation has been accepted as a negative predictive factor for the treatment of cetuximab. In contrast, no valid biomarkers for bevacizimab were found so far. More studies are necessary to identify biomarkers of targeted agents. Recent advancement of chemotherapeutic agents extended survival in colorectal cancer.

Keyword

Colorectal cancer; Chemotherapy; Targeted agents

MeSH Terms

Antibodies, Monoclonal, Humanized
Bevacizumab
Biomarkers
Capecitabine
Camptothecin
Cetuximab
Chemoradiotherapy
Chemotherapy, Adjuvant
Colonic Neoplasms
Colorectal Neoplasms
Cytotoxins
Deoxycytidine
Fluorouracil
Humans
Organoplatinum Compounds
Receptor, Epidermal Growth Factor
Rectal Neoplasms
Antibodies, Monoclonal, Humanized
Camptothecin
Cytotoxins
Deoxycytidine
Fluorouracil
Organoplatinum Compounds
Receptor, Epidermal Growth Factor

Figure

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  Figure 1 Recent improvement of overall survival in patients with metastatic colorectal cancer.

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